From Crisis to Control: New Clinic for Uncontrolled High Blood Pressure
BIDMC Contributor
SEPTEMBER 07, 2023
Oded Gefen has no intention of retiring. The active 79-year-old works as a computer engineer designing fiber-optic networks. He enjoys taking walks outdoors near his Needham home, which he’s shared with his wife for more than two decades. Oded believes, “You need a challenge every day, to wake up and do something useful that helps you and others.”
For years this father of three and grandfather of seven struggled with hypertension or high blood pressure. Hypertension is very common and occurs in nearly half of adults in the United States (119.9 million), according to the U.S. Centers for Disease Control and Prevention.
Hypertension can be known as a “silent killer,” as people with the condition often have no obvious signs or symptoms. If left untreated, hypertension increases one’s risk for stroke, heart attack, and congestive heart failure.
In 2019, Oded made several visits to the emergency room for a condition called lymphedema. It caused swelling in his right leg, and his body did not react well to medications for this condition. Likewise, the multiple medicines that were prescribed to lower blood pressure were not controlling his hypertension. These were clues that something more complex was happening in Oded's body and affecting his blood pressure.
Getting to the Root Cause of Uncontrolled Hypertension
Oded was referred to Brett Carroll, MD, Director of Vascular Medicine at BIDMC, and underwent multiple medical tests to better understand his cardiovascular health. Dr. Carroll discovered Oded had narrowed arteries in his kidneys that restricted blood flow, contributing to his high blood pressure.“Narrowing of the kidney arteries can be a cause for difficult to control hypertension, but we are selective when deciding which patients would benefit from a procedure to correct this condition,” commented Dr. Carroll. It was appropriate to have other experts in hypertension review his case at the Complex Hypertension Clinic (CHC). The Clinic, directed by primary care physician Jennifer Cluett, MD, opened earlier this year at BIDMC and provides testing, evaluation, and personalized treatments.
“Any patient whose blood pressure is not controlled is a good candidate for the CHC,” explains Anna Krawisz, MD, lead cardiologist at the CHC. “We have the resources to serve patients with complex medical histories or multiple health concerns happening at once.”
The team looked at other causes of high blood pressure and continued to adjust his medications. Oded’s blood pressure remained high. After a discussion among the various specialists at the CHC, improving the blood flow to the kidney through a minimally invasive procedure was Oded’s best option.
Oded was confident in the team and underwent renal artery stenting performed by Eric Secemsky, MD, Director of Vascular Intervention at the Cardiology Catheterization Lab at BIDMC. Within a few months and after further medication adjustments, Oded’s blood pressure reached and remains within a normal range.
Why Uncontrolled Hypertension Needs Specialized Care
One of the things that makes treating uncontrolled hypertension so difficult is that patients often don't feel sick. That lack of symptoms makes knowing where to begin treating uncontrolled hypertension challenging. Dr. Cluett says that is why the CHC provides comprehensive evaluations to determine the root cause of hypertension.
“Rarely is there a ‘cure’ for hypertension,” added Dr. Krawisz. “But, with expertise from our multidisciplinary team of specialists, including endocrinologists, nephrologists, and interventional radiologists, we can identify any secondary—or underlying— medical reasons for hypertension that may need targeted treatment. From there, we develop a coordinated treatment plan with the patient.”
Oded said having different medical experts at the CHC coordinating his care behind the scenes made all the difference. “All of them talked and came together to work on solutions. I didn’t have to go to different offices and explain myself to different doctors. When the renal artery stent procedure was proposed to me, I was confident it was the right decision because of how thorough and thoughtful my evaluation and care had been.”
As an academic medical center, patients also benefit from the latest research and advanced treatment options. The CHC is participating in a clinical trial in which the patient undergoes a procedure that calms excessively active nerves connected to the kidneys that may contribute to high blood pressure.
Oded’s Return to Health from Uncontrolled Hypertension
Oded received treatment from Dr. Krawisz, and the CHC team customized to his specific health needs. Finding the deeper cause of his hypertension through the CHC reminded Oded of the similarities between his work and the work of the CHC team. “The body is somewhat of an engineering product; the brain is essentially a computer,” Oded reasons. “It sends commands and gets feedback, a lot like what happens in medicine. They look deeper and try different interventions that better control parts of the body.”
Today, Oded’s blood pressure is in the normal range. He checks in regularly with his care team at BIDMC to stay ahead of his hypertension. True to his character, this computer engineer’s life remains vibrant. He recently returned from a trip to Israel to visit family and said he was glad his hypertension is now under control.