You may have been told you need to see a specialist to treat your high blood pressure if:
- you are taking three or more blood pressure medicines and your blood pressure is still high or uncontrolled;
- you are having trouble tolerating high blood pressure medicine either because of allergies or side effects;
- an underlying condition is suspected to be causing your high blood pressure.
Duke high blood pressure specialists include cardiologists, nephrologists and endocrinologists who understand the complexities of hypertension. They are experts in treating people with resistant hypertension that hasn’t responded to aggressive treatment, as well as secondary hypertension that may be related to heart disease, kidney disease, a hormonal condition or another medical concern. They are dedicated to finding the ideal medication or combination of medications to lower your blood pressure, and also to educate you to accurately monitor and track your levels.
Primary Hypertension, Secondary Hypertension and Resistant Hypertension
Primary hypertension occurs when the blood pressure in your arteries is too high. This makes your heart work harder to pump blood through 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 smoking cessation, diet, exercise, and antihypertensive medications. However, you may be referred to a high blood pressure specialist if resistant or secondary hypertension is present.
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:
- African Americans
- People with obesity
Allergies to or side effects from certain medications can also cause resistant hypertension. Common medications associated with resistant hypertension include:
- Non-steroidal anti-inflammatory medicines
- Oral contraceptives
- Cold and cough medicines including nasal decongestants
- Herbal supplements such as ginseng and licorice
- Stimulants like caffeine, ADHD medications
- Overuse of salt and alcohol
Sometimes an underlying condition is responsible for your high blood pressure. This is known as secondary hypertension. Conditions that contribute to secondary hypertension include:
Duke Health offers locations throughout the Triangle. Find one near you.
Why Choose Duke
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.
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 dietician. 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
Several ongoing research studies at Duke are looking at the influence of various lifestyle factors, testing cell phone apps, and studying new medical therapies. You may be eligible to participate in some of these research projects and benefit from these advances before they are widely available.
Renal Denervation Trial
An ongoing trial at Duke is testing a minimally invasive procedure to determine its effectiveness in lowering blood pressure in people who have been diagnosed with hypertension. If you are eligible to participate, a catheter is used to access your renal arteries, where a pulse of radiofrequency energy is delivered to deaden overactive nerves that can be a cause of hypertension. Once the activity of these nerves is reduced, the body responds by lowering your heart rate and other factors that appear to lower blood pressure.
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.
When it comes to your heart care, you want the very best. Duke University Hospital's nationally ranked cardiology and heart surgery program is ranked the best in North Carolina by U.S. News & World Report for 2019–2020.