Complex Hypertension: When to Refer
Managing patients with uncontrolled hypertension can be time consuming and challenging. If you've optimized medical therapy, it might be time to explore treatment options with hypertension experts to achieve blood pressure goals.
Pearls for Optimizing Medical Therapy
- Use a high-potency & long-acting first-line agent
- Use once daily rather than twice daily dosing when possible
- Prescribe generic single-pill combination tablets to reduce pill burden and copays
When to Refer
Consider referring complex cases that would benefit from:
- A multi-specialty approach to evaluation and treatment
- Frequent touch points for medication titration
- Procedural options such as:
Renal Denervation
For those unfamiliar with RDN, it’s an outpatient procedure that ablates renal sympathetic nerves to lower blood pressure. It has an excellent safety profile. Eric Secemsky, MD, has performed a high volume of cases at BIDMC, has trained over 40 physicians in the technique, and is involved in research and monitoring results in collaboration with the American College of Cardiology.
BIDMC Complex Hypertension Clinic
The BIDMC Complex Hypertension Clinic evaluates and treats patients with difficult-to-control blood pressure and can also assess eligibility for procedural interventions. Jennifer Cluett, MD, directs the clinic in collaboration with lead cardiologist Anna Krawisz, MD, and other specialists from endocrinology, nephrology, and general medicine.
How to Refer
