This week, Bobbi Conner talks with Dr. Natalie Freidin about resistant hypertension, or hard-to-control high blood pressure. Dr. Freidin is an Associate Professor of Medicine and a kidney specialist who treats patients in the Advanced Hypertension Clinic at MUSC.
TRANSCRIPT:
Conner: I'm Bobbi Conner for South Carolina Public Radio with Health Focus here at the radio studio for the Medical University of South Carolina in Charleston. It's estimated that nearly 47% of adults in the U.S. have high blood pressure, and about 10 to 20% of these individuals have difficulty controlling their blood pressure with standard treatments. Doctor Natalie Freidin is here to talk about resistant hypertension. Doctor Freidin is an Associate Professor of Medicine, and she's a kidney specialist who treats patients in the multidisciplinary Advanced Hypertension Clinic at MUSC. Doctor Freidin, first tell us more about hard to treat or resistant high blood pressure.
Dr. Freidin: Resistant hypertension or hard to treat high blood pressure is when we use three or more medications, including a water pill, to be able to bring down someone's blood pressure to goal.
Conner: Why is it so important to effectively manage or reduce high blood pressure for everyone?
Dr. Freidin: So, the number one killer for most people in America is heart disease, 1 in 2 people. And the number one cause for that is high blood pressure. So, it is very important that we find people who have high blood pressure and treat it effectively, because we will save more lives treating this particular condition than any other medical condition.
Conner: I understand resistant hypertension often coexists with other chronic cardiovascular risk factors like smoking, higher weight, diabetes, chronic kidney disease, and these are all additive risk factors. Tell us more about that.
Dr. Freidin: So, as you know, I'm a kidney specialist and I always think all roads lead to the kidney. When I treat high blood pressure, I'm treating the cardiovascular risk factors, but I'm looking at all the other things that people have as well. And part of my job as a physician is to treat those. So, if I have a patient who's smoking, I know their risk of having a heart attack or a stroke with high blood pressure is higher than if they didn't smoke. The same with kidney disease. So, if they have kidney disease and high blood pressure, I'm going to be a lot more aggressive in my treatment of them to really bring down their risk factors for a cardiovascular outcome.
Conner: Well, what's the connection between chronic kidney disease and resistant hypertension?
Dr. Freidin: So, this is one of my favorite topics as a kidney specialist. We often joke that cardiologists think that they manage high blood pressure, but truly it's the kidney that manages high blood pressure because high blood pressure is a result of too much fluid and too much salt in the body. And all of that fluid and salt is handled by the kidney. And so, in managing kidney disease, we also manage resistant hypertension. As people develop worsening kidney disease, they tend to have more and more difficult to control high blood pressure. As a result, the drugs that we use to treat this condition tend to target the kidney specifically.
Conner: And all of these kind of medications and tools, so to speak, are effective? In other words, you can figure something out for patients who do have hard to treat hypertension?
Dr. Freidin: Absolutely. The medications that we have, and there are so many I can't list them now, are incredibly effective. And we have decades of evidence based data to support that. They work. And we know in practice that they work and they slow down progression of kidney disease, reduce mortality so less people die and live longer, healthier lives, which is ultimately our goal.
Conner: And a good starting point for everyone really, is to find out if they have high blood pressure in the first place.
Dr. Freidin: I would say the first place to start because high blood pressure is really a silent killer, starting by having your blood pressure screened every year by your primary care physician.
Conner: Doctor Freidin, thanks for talking with us about resistant hypertension.
Dr. Freidin: You're welcome. It was wonderful being here.
Conner: From the radio studio for the Medical University of South Carolina in Charleston, I'm Bobbi Conner for South Carolina Public Radio.
Health Focus transcripts are intended to accurately represent the original audio version of the program; however, some discrepancies or inaccuracies may exist. The audio format serves as the official record of Health Focus programming.
