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Resistant Hypertension: Controlling Blood Pressure Via New Program at Baptist Health's Miami Cardiac & Vascular Institute


Nearly half of adults in the U.S., or about 108 million, have hypertension, or high blood pressure. An even more concerning fact: Only about 1 in 4 adults (24 percent) with hypertension have their condition under control.

Ian Del Conde, M.D.

Ian Del Conde, M.D.

About a year ago, as the COVID-19 pandemic was underway, Miami Cardiac & Vascular Institute launched its Resistant Hypertension Program, and it's thriving, according to its director, Ian Del Conde, M.D., associate chief of Cardiology and medical director of Vascular Medicine at Miami Cardiac & Vascular Institute.

"Resistant hypertension basically means that you have elevated blood pressures despite using multiple appropriate medications,” explains Dr. Del Conde. “Resistant hypertension is common, and when we see a patient with it, we consider a number of factors that could be driving the patient's high blood pressure. It's not just a matter of increasing the doses or increasing the number of blood pressure medications."

How the Program Works

The goal of the Institute's Resistant Hypertension Program is to get a patient's high blood pressure under control within two or three months of starting treatment. Initially, each patient undergoes a comprehensive evaluation to determine the potential factors that could be driving the resistant hypertension. 

Gene Harlamov, an advanced practice practitioner with additional certification in hypertension, helps run the Hypertension Clinic, and ensures that patients are being followed frequently, reporting their blood pressure logs, and making any necessary adjustments to medications.

The Hypertension Clinic also provides advanced patient remote monitoring, a technology-driven method of managing patients’ chronic conditions, including hypertension, around the clock. If sleep health is a factor contributing to resistant hypertension, the patient may be referred to the Institute’s Sleep Medicine and Continuous Improvement program.

“We systematically assess patients for associated conditions that could the reason behind the elevated blood pressures,” says Dr. Del Conde. “Notable examples include sleep apnea, dietary factors, or use of other medications or supplements that could by themselves increase a person’s blood pressure.”

High blood pressure on its own -- defined as a systolic reading of greater than 130 mm Hg (the top number) and a diastolic reading of greater than 80 mm Hg (the bottom number) -- is a major risk factor for heart disease and stroke – the two leading causes of death in the world. Left uncontrolled, high blood pressure can cause serious problems for your heart, including coronary artery disease, causing the narrowing of arteries. And it can also lead to heart failure over time, which causes the heart muscle to weaken and work less efficiently. 

Program is ‘Growing Very Fast’

Many healthcare systems are "not conducive to good blood pressure management," explains Dr. Del Conde. Sometimes that means seeing your doctor every few months at the most. 

"That's not going to work," continues Dr. Del Conde. "Having a hypertension clinic allows patients to be seen quickly, either in person or virtually, for rapid and frequent assessment of their blood pressure and adjustments as needed of medications based on those blood pressure readings.  

More and more primary care physicians and cardiologists are referring patients to the Institute's Resistant Hypertension Program/

"The program has been growing very fast," said Dr. Del Conde. "We do many of our visits virtually. We want the program to be not only effective for the patient, but also convenient.” 

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