The Curbsiders Internal Medicine Podcast #474 Resistant Hypertension the Next Frontier
54 snips
Mar 10, 2025 In this engaging discussion, Dr. Jordana Cohen, a nephrologist and hypertension specialist from the University of Pennsylvania, shares her insights on managing resistant hypertension. She dives into innovative treatments, including GLP-1 agonists and aldosterone synthase inhibitors, and discusses emerging therapies that show promise. The conversation also highlights the evolution of blood pressure measurement techniques and the significance of personalized treatment plans, offering practical advice and new hope for tackling this widespread condition.
AI Snips
Chapters
Transcript
Episode notes
Starting Doses and Medication Needs
- Clinicians often start with medium medication doses, fearing a large blood pressure drop, but this is rarely seen clinically.
- Most patients require three medications to reach a goal of less than 130/80.
Initial Treatment Strategy
- Start new hypertension patients on two medications, such as a fixed-dose combination of amlodipine and an ARB.
- Set expectations by informing patients that full effects may take 2-4 weeks.
Adding a Third Agent
- If a patient remains uncontrolled on two medications, add a third agent (e.g., a diuretic) rather than maxing out the initial two.
- This strategy minimizes side effects while maximizing blood pressure lowering.