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>> So resistant hypertension is a hypertension
that is not controlled with three or more medications,
including a diuretic, which is a water pill.
We don't know exactly what causes it.
There is multi genes that can be responsible
for resistant hypertension.
But we do know that patients who have
resistant hypertension are more likely to have
an identifiable cause.
20% of those patients there is a cause
that we can define and therefore treat accordingly.
It's diagnosed by accurate measurement of blood pressure.
And taking a thorough history and physical exam.
Most of the problems that we deal with
in these days is that patients rush to the office
when their blood pressure is determined,
and sometimes that blood pressure
is not accurately reflecting what the blood pressure is.
So we reinforce different measurements.
And we are now, in the last few years,
encouraging to determine blood pressure at home.
Which is more important than whatever reading
we get in the office.
It is estimated now that 100 millions peoples
in the U.S. have hypertension.
And approximately a fourth of that,
that's 20-25 million have resistant hypertension.
So those patients are at higher risk,
so it's important to define that population
and aggressively treat them.
The treatment options, and this is what we do
in the Hypertension Center here at Hopkins
is to first of all personalize care of these patients.
And try to educate the patient first.
Try to modify habits and lifestyle.
And then combine drugs that are appropriate
for that specific patient.
So in our Hypertension Center,
we are a multidisciplinary center
with people who are really obsessive compulsive
about treating and managing hypertension.
And we are now, not only educating people,
and providing information on how to measure blood pressure
and what lifestyle modifications they do,
we do some noninvasive testings,
such as measuring central aortic pressure,
which is the pressure closest to the heart and to the brain.
Which sometimes, in certain patients,
do not reflect the pressure in the arm
that we routinely measure.
And we are also doing something that is very new.
We are doing a saliva or blood sample of genes.
And based on those genes, we target the treatment.
So to give you an example,
there are certain patients who are more responsive
to medication A or B,
and we are able to tell that
by doing a genetic profile of those patients.
Something very new.
And something that in Europe
is being going on for a few years now.
Last year in 2017, the American College of Cardiology
and the American Heart Association
got together and decided to update
our hypertension guidelines.
And this created a little bit of confusion
among physicians and as well as patients.
And this is because before we would call hypertensive
that patient who will have a higher number,
a number above 140 over 90.
Now we drop the bar to 130 over 80.
Meaning that having normal blood pressure remains the same.
If you have 120 over 80 or less,
your blood pressure is considered normal.
But now, if you have 130 over 80 or more
then you are hypertensive.
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