Cardiologist explains Resistant Hypertension
Cardiologist explains Resistant Hypertension
In this video I’m going to tell you about resistant hypertension.
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Content
0.56 -> hello everyone in this video I'm going
4.02 -> to tell you about a condition called
6.06 -> resistant hypertension
8.76 -> if you're new to the channel I'm Hafiz
11.16 -> and I'm a cardiologist training in
13.2 -> London
14.16 -> here I explain heart conditions in a way
16.92 -> that is easy to understand and I also
19.56 -> provide teaching for medical students
21.6 -> and Junior doctors
24.06 -> if you want to know more about your
26.58 -> hearts and learn about heart disease
28.74 -> then hit the Subscribe button and Bell
31.5 -> icon so you get a notification every
34.02 -> time I post a video
36.84 -> when you're diagnosed with high blood
39.42 -> pressure also called hypertension you'll
43.02 -> be prescribed medications to control
44.879 -> your blood pressure
47.28 -> if one agent isn't enough to control
49.5 -> your blood pressure other agents that
52.26 -> have different mechanisms of action will
54.66 -> be added
56.46 -> resistant hypertension is blood pressure
59.64 -> that remains High despite using at least
62.78 -> three blood pressure medications of
65.7 -> different classes
67.32 -> these would typically be a calcium
69.6 -> channel blocker an inhibitor of the
72.24 -> renin Angiotensin system and a diuretic
75.5 -> all these agents should be prescribed at
78.54 -> the maximum tolerated dose
81.6 -> we worry about resistant hypertension as
85.14 -> it's associated with an increased risk
87.479 -> of premature cardiovascular disease such
90.54 -> as heart disease and stroke
93.18 -> approximately 20 of people with high
95.82 -> blood pressure have treatment resistant
98.22 -> disease
100.92 -> cases of resistant hypertension should
103.619 -> be referred to a blood pressure
105.36 -> specialist
107.24 -> The Specialist can be a cardiologist
110 -> clinical pharmacologist or sometimes a
113.579 -> kidney doctor
115.32 -> the blood pressure specialist will do
117.84 -> the initial workup to rule out
120.2 -> pseudo-resistant hypertension which is
122.82 -> also known as white coat hypertension
125.82 -> I've done a separate video on this
127.619 -> condition so you can watch that video
129.84 -> after
131.84 -> The Specialist will also check for
134.66 -> non-adherence to medication
137.4 -> and make sure you actually take the
140.52 -> medications but also taking them
142.8 -> correctly
144.92 -> non-adherence to medication is a
147.36 -> challenge in blood pressure management
150.54 -> checking for adherence takes time and
154.319 -> resources it requires a Frank discussion
158.04 -> with the patient to ensure they are
160.02 -> taking the blood pressure medications as
162.9 -> prescribed
164.879 -> there are also other direct techniques
168.239 -> to measure non-adherence by urinary or
171.54 -> blood measurements or the active drug
174.36 -> this is important to ensure we do not
176.84 -> escalate treatment in a patient who is
179.76 -> not taking the medications in the first
182.04 -> place
183.54 -> this can cause lots of problems to the
186.599 -> patient including low blood pressure and
189.42 -> side effects for medications that they
191.7 -> may not even need
194.459 -> and finally as part of the workup the
197.099 -> blood pressure specialist will screen
198.72 -> for secondary causes of hypertension
203.22 -> in one in five cases of resistant
205.5 -> hypertension there is an identifiable
207.959 -> course
209.76 -> there are a number of conditions that
212.28 -> can cause hypertension such as primary
215.34 -> aldosterism
217.68 -> chronic kidney disease renal artery
220.14 -> stenosis obstructive sleep apnea and
223.26 -> rarer causes such as verochromocytoma
226.379 -> of these the most common cause of
229.92 -> secondary hypertension is primary
232.04 -> aldosteroneism also known as con
234.48 -> syndrome
236.22 -> this is when your adrenal glands which
239.34 -> is just above your kidneys produces too
242.4 -> much aldosterone
244.64 -> aldosterone is a sterile and it controls
248.099 -> sodium and potassium levels in your
250.379 -> blood
252.12 -> it increases plasma sodium by increasing
255.659 -> sodium reabsorption in the kidneys
257.82 -> causing water retention
260.22 -> it is diagnosed by measuring your serum
263.06 -> aldosterone plasma read inactivity and
266.82 -> electrolytes
268.38 -> typically in concentrome you have low
271.44 -> renin low potassium high sodium and
275.58 -> aldosterone
277.5 -> some patients with treatment resistant
279.84 -> hypertension have been found to have
282.66 -> increased aldosterone production even
285.78 -> though they do not have primary
287.82 -> aldosteroneism
290.58 -> there is a lot of research interest in
293.58 -> this area
295.46 -> recently a new drug called baxterostats
298.979 -> just completed the phase 2 trial
302.28 -> it works by blocking an enzyme called
304.88 -> aldosterone synthase that catalyzes the
308.82 -> final steps of adosterone synthesis from
311.04 -> cholesterol
312.32 -> this medication raises hope for patients
315.6 -> with treatment resistant disease
319.5 -> so to summarize resistant hypertension
322.5 -> is seen in about 20 of people with high
325.139 -> blood pressure
326.66 -> in cases of resistant hypertension the
330.12 -> patient should be under the care of a
332.82 -> blood pressure specialist
334.8 -> and investigation should be performed to
337.259 -> rule out White Coat Syndrome treatment
340.639 -> non-adherence and secondary causes of
343.979 -> hypertension
345.96 -> I hope that was helpful and thanks for
348.3 -> watching
Source: https://www.youtube.com/watch?v=XeDor40QPgM