Comprehensive Hypertension Center (ASH-certified)

Hypertension, also known as high blood pressure, is a condition characterized by elevated blood pressure in the arteries. Systolic blood pressure is the top number in a blood pressure reading, and refers to the pressure in the arteries when the heart beats or contracts. Diastolic blood pressure is the bottom number, and refers to the pressure in the arteries between heartbeats. When blood pressure is high it can be very dangerous, contributing to a variety of health problems including:

• Heart disease/ coronary artery disease
• Stroke
• Chronic kidney disease
• Peripheral artery disease
• Aneurysms

Hypertension is known as the "silent" disease, because often times it will not accompany symptoms. However, the following symptoms may occur:

• Headache
• Fatigue
• Confusion
• Vision problems
• Chest pain
• Difficulty breathing
• Irregular heartbeat
• Blood in the urine
• Pounding in your chest, neck, or ears

Hypertension is a leading cause of death and disability in the U.S. and worldwide. Over 60 percent of people over the age of 65 have high blood pressure, and the number of people with high blood pressure is steadily increasing. Early diagnosis is the key to managing and treating hypertension before serious health problems and complications occur. At Penn, we offer the latest advancements in diagnostic procedures for patients with hypertension and associated disorders.

Typical diagnostic procedures and tests include:

• Physical examination
• Echocardiogram
• Electrocardiogram
• Blood tests
• Testing to check renin activity and aldosterone levels

Other diagnostic testing such as ambulatory blood pressure monitoring and non-invasive vascular studies may also be done to measure blood pressure and assess cardiovascular health.

Ambulatory Blood Pressure Monitoring

Blood pressure monitoring is extremely important in detecting hypertension. Ambulatory blood pressure monitoring is a valuable diagnostic tool that looks at the way the circulation functions, and can be used to analyze a patient's response to treatment. Findings can also be used in research to predict future outcomes for patients.

During this test, a small blood pressure machine is attached with a belt around the body and a cuff is placed around the arm for 24-hours to measure blood pressure while a patient goes about their daily life. The test obtains a 24-hour record of a patient's blood pressure, and can detect "white coat" hypertension, a phenomenon that occurs when a patient experiences high blood pressure that appears more elevated during clinical visits.

Non-invasive Vascular Studies

Several non-invasive vascular studies may be done to measure various aspects of blood vessel function and how that relates to consequences of hypertension, including kidney disease progression, heart failure, stroke and peripheral artery disease. These procedures include:

• Central pressure measurements
• Aortic augmentation index
• Measurement of arterial stiffness using pulse wave velocity

These three procedures measure the velocity at which pulse waves travel in the circulation, and how the pulse waveform changes as it leaves the heart. These tests help assess cardiovascular health and aid in examining the effects of different types of treatments.

At Penn, our physicians are ASH-certified Clinical Hypertension Specialists that work in a multidisciplinary manner to create individualized treatment plans for every patient. Typical treatments include medication and changes in diet and lifestyle.

Diet and Lifestyle Changes

Diet and lifestyle changes are critical to managing high blood pressure. Lifestyle changes to control or prevent hypertension include:

• Dietary approaches to stop hypertension such as the DASH diet which consists of nutrient rich foods, fruits, vegetables, whole grains, low sodium, low saturated fat and low in dairy
• Smoking cessation
• Eliminating alcohol
• Maintaining a healthy weight
• Exercise
• Stress management

Medications

Careful balancing and monitoring of medications is extremely important in each individual patient. Medications to manage hypertension may include:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Diuretics
• Beta-blockers
• Calcium channel blockers
• Alpha-blockers
• Alpha-agonists
• Renin inhibitors
• Combination medications

Penn's Comprehensive Hypertension Center is involved in a number of NIH-funded research studies. Studies include looking at optimal goal blood pressure levels, different therapies to treat hypertension and alternative treatments such as yoga for mild hypertension. Penn was involved in the Systolic Blood Pressure Intervention Trial (SPRINT) which has laid the foundation for the new BP Guidelines from the AHA/ACC. We are also involved in new technologies to lower BP including renal denervation studies. We are currently conducting the following studies:

• Chronic Renal Insufficiency Cohorts (CRIC) - Designed for patients with chronic kidney disease, this study looks at every aspect of chronic kidney disease genetics, echocardiography, blood tests and pulse wave studies. The current focus is on patients with proteinuria (dipstick-positive protein in the urine), and how that influences kidney function and the occurrence of cardiovascular disease. Patients are seen once a year and findings are reported to their physicians.
• SPYRAL OFF MED Study - The objective of this study is to evaluate safety and the blood pressure response after renal denervation in patients with uncontrolled hypertension on one, two, or three standard antihypertensive medications compared to a sham-controlled population. In this study, "uncontrolled hypertension" means an office systolic blood pressure (SBP) ≥150 mmHg and <180 mmHg, an office DBP ≥90 mmHg and a 24-hour Ambulatory Blood Pressure Monitoring (ABPM) average SBP ≥140 mmHg to <170 mmHg measured at Screening Visit 2.
• Management of Hypertension and Body Composition Study – The goal of this study is to evaluate the effect of body composition on how blood pressure medication classes impact degree of blood pressure control throughout the day. To be included in the study, we ask that patients be on a stable dose of no more than one blood pressure medication for at least 2 months. Patients will be asked to undergo 24-hour ambulatory blood pressure monitoring, which will measure blood pressure every 15-30 minutes over 24-hours, and to complete a dual x-ray absorptiometry (DXA) scan. Patients and their care team will receive the results of all of the testing.