Clinical Strategies For Managing Resistant Hypertension: Emerging Tools and Therapeutic Insights - Episode 2
Collaborating in a Multidisciplinary Team to Control Resistant Hypertension
Panelists discuss how patients with resistant hypertension should be referred to specialists after 3 to 6 months of unsuccessful treatment, emphasizing that while primary care providers can manage most hypertension cases, specialists with particular interest and experience are needed for complex cases.
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The management of resistant hypertension requires a collaborative approach between primary care providers and specialists, though primary care physicians should be empowered to manage the majority of hypertensive patients. Referral to specialists should be considered when blood pressure goals are not achieved after 3 to 6 months of appropriate therapy, when secondary causes are suspected, or when patients have complex comorbidities requiring specialized expertise.
The choice of specialist varies by community resources and expertise, with referrals potentially going to cardiologists, nephrologists, or endocrinologists depending on local availability and the specialist’s particular interest in hypertension management. The key is identifying health care providers in each community who have developed expertise and maintain a systematic approach to resistant hypertension evaluation and treatment, rather than focusing solely on specialty designation.
Effective management requires a step-wise approach including ruling out pseudoresistance, identifying and treating secondary causes, eliminating interfering substances, implementing lifestyle modifications, and optimizing background antihypertensive therapy. This systematic methodology can be successfully implemented by well-trained primary care providers with appropriate specialist support when needed, ensuring that the millions of patients with resistant hypertension receive optimal care despite specialist availability limitations.
