Treating Difficult Cases of Hypertension: AHA Comprehensive Hypertension Center Designation

Certification of the Columbia Hypertension Center as an American Heart Association Comprehensive Hypertension Center is official recognition that Columbia is a leader in the care of patients with high blood pressure.

The Columbia Hypertension Center is one of only 17 centers in the country to receive the certification and the only one in the New York City metropolitan area. The center is led by internist Ian M. Kronish, MD, associate professor of medicine; cardiologist Daichi Shimbo, MD, professor of medicine; and nephrologist Jai Radhakrishnan, MD, professor of medicine.

The center offers patients with complex or difficult-to-treat cases of hypertension, or those who are difficult to diagnose, the most up-to-date diagnostic and treatment strategies based on the latest proven scientific research.

Centers seeking AHA certification undergo an intensive review by specialists in hypertension. Certified centers must be recognized as referral centers for complex cases and cases caused by other health conditions and have facilities and personnel able to assess and evaluate complicated hypertension problems.

Almost half of adults in the United States have high blood pressure, and many don’t know it. And some 40% of people diagnosed with hypertension do not have their blood pressure under control.

Most patients at the center have uncontrolled hypertension that needs better management. In many people, blood pressure can be controlled by adopting a healthy lifestyle—eating a healthy diet, losing weight, and increasing physical activity. Most patients also need medication to lower blood pressure.

Measuring blood pressure accurately is the first step in providing the right care. “Blood pressure problems are easily misdiagnosed,” Dr. Shimbo says. “Blood pressure is easy to measure but not easy to measure accurately.”

Part of the problem lies with blood pressure devices. Many devices, even those commonly used by health care providers, have not been validated for accuracy. In addition to using validated devices in the office, Columbia’s center provides patients with ambulatory or home monitoring devices to measure blood pressure. This includes home blood pressure devices that automatically transmit blood pressure numbers into a patient’s electronic health record. The data allow clinicians to make better decisions about how much medication patients need.

“Out-of-office blood pressure may be substantially different from blood pressure measured in the office,” Dr. Shimbo says, “and people who only have high blood pressure in the office—also known as white coat hypertension—may not need the same treatment as those with sustained high blood pressure both inside and outside the office.”

When a patient is diagnosed with high blood pressure, the next step is determining the cause. Some hard-to-treat cases are caused by other medical conditions, including kidney disease, thyroid abnormalities, and sleep apnea. The Columbia Hypertension Center can perform all the tests needed to pinpoint the cause and administer the right treatment, whether it requires medication, surgery, or an alternative intervention.

Patients who suspect they have high blood pressure, who were recently diagnosed and want to learn how to control it, or who have high blood pressure that is not well controlled can contact the Columbia Hypertension Center at (212) 342-1273 or request an appointment online through columbiadoctors.org