Analyzing Complex Hypertension Cases

Friday, October 14 at 11:00am

Attendees at today's "Complex Cases in Hypertension" presentation can look forward to an in-depth analysis of recent changes in definitions and treatment goals for hypertension, the principles of evaluation to complex hypertension cases encountered in clinical practice, and the adverse events and difficulties that impart cardiovascular risk in patients with hypertension.

James Matera, DO, FACOI, co-director of physician integration at CentraState Medical Center, will discuss the scope of hypertension in the United States, where 75% of patients age 75 and older deal with high blood pressure, which is a leading cause of disability, morbidity, and mortality.

Guidelines "have been inconsistent" in looking at target blood pressure goals in this population, says Matera, who plans to present a pair of case studies as examples of particularly complex hypertension cases.

Matera will also look at the types and causes of resistant hypertension. Apparent resistant hypertension, for instance, is marked by medication non-adherence and pseudohypertension. Meanwhile, true resistant hypertension may be linked to factors such as medication and illicit drug use, excessive alcohol consumption, herbal medicines, obstructive sleep apnea, obesity, and weight-loss medicines. Secondary causes of hypertension can include primary aldosteronism (excess amount of aldosterone secretion, adenoma), renovascular disease, and pheochromocytoma, adds Matera.

In addition, Matera intends to share approaches that may be beneficial with respect to treatment of resistant hypertension. Alpha-blockers, and centrally acting anti-hypertensive drugs such as clonidine and alpha-methyldopa, for example, may be of potential benefits in many patients, when added to previous therapy, he says, adding that many studies indicate that mineralocorticoid receptor antagonists such as spirolactone are the drugs of choice in the treatment of resistant hypertension.

"Since hypertension permeates the daily practice of medicine, physicians often become frustrated with difficult-to-manage patients," says Matera. "This lecture will present 2 cases of difficult management scenarios and go through some logical steps to addressing the road barriers to treatment success. The cases will bring us right into the treatment room with the patient and discuss options for better management."

—Mark McGraw