Hypertension

Primary Hypertension
Primary hypertension occurs when the blood pressure in your arteries is too high. This makes your heart work harder to pump blood throughout your body. High blood pressure rarely causes symptoms, but the damage it does to your arteries can be severe. Left untreated, it can lead to heart attack, kidney failure, and stroke. Unchecked high blood pressure can also damage your vision and memory. It is associated with erectile dysfunction.

Primary hypertension can be treated by your primary care doctors with lifestyle changes -- including maintaining a healthy body weight, eating a healthy diet that is low in salt, exercising, and limiting alcohol -- and antihypertensive medications. However, you may be referred to a high blood pressure specialist if resistant or secondary hypertension is present.

Resistant Hypertension
Resistant hypertension occurs when three or more antihypertensive medications fail to bring your high blood pressure under control. People more likely to experience resistant hypertension include:

• Women
• African Americans
• People with diabetes
• People with obesity

Allergies to or side effects from certain medications can also increase blood pressure. Common medications that can increase blood pressure include:

• Non-steroidal anti-inflammatory medicines (NSAIDs)
• Oral contraceptives
• Cold and cough medicines including nasal decongestants
• Herbal supplements such as ginseng and licorice
• Stimulants like caffeine, ADHD medications

Secondary Hypertension
Sometimes an underlying condition is responsible for your high blood pressure. This is known as secondary hypertension. Conditions that contribute to secondary hypertension include:

• Kidney disease
• Heart disease
• Adrenal gland disorders
• Thyroid conditions
• Sleep apnea

Comprehensive Testing and Evaluation
If you have been referred to a Duke high blood pressure specialist, your primary care doctor suspects you need a more in-depth evaluation. After conducting a comprehensive physical exam and analysis of your medical history, our high blood pressure specialists may recommend a variety of tests to determine the cause.

Blood Pressure Medications
Side effects and allergies can cause some people to stop taking their medication, or to take it incorrectly, which makes it less effective. Our specialists recommend the right combination and dosage of medications to bring your blood pressure under control. They will also work to eliminate medications that you no longer need.

Hypertension Clinics
We provide the resources you need. Depending on your individual needs, your care may include visits with a cardiologist, nephrologist, endocrinologist, exercise physiologist, and a dietitian. We address all the lifestyle and medical components you need to bring your high blood pressure under control.

Blood Pressure Monitoring Education
Learning how to measure your blood pressure at home is important; our specialists ensure you are doing it correctly. They check your home monitors to make sure they are accurate and explain the significance of keeping blood pressure diaries so they can review accurate readings taken at different times during the day. This also ensures your numbers aren’t influenced by “white coat hypertension,” a false elevation in blood pressure that occurs in some people when they visit the doctor.

Clinical Trial Access
As a Duke patient, you may be eligible to participate in clinical research studying new medical therapies and other ways to improve high blood pressure care. You could have access to advances before they are widely available.

We Work Closely with Your Primary Care Doctors
Our hypertension clinics are not meant to replace your primary care doctors. Our high blood pressure specialists take an active role in bringing your hypertension under control, then work with your primary care doctors to ensure your therapy continues. We are available for periodic check-ins as needed.