From Crisis to Control: A Physician’s Experience with Resistant Hypertension

How David Found Specialized Care When His Blood Pressure Remained Dangerously High

When David’s blood pressure escalated into the crisis zone and stayed there, he was scared. For the first time in over 30 years of practicing medicine, he was not in control of his health.

Managing high blood pressure wasn’t new to the 60-year-old physician. He had been on medication since his 30s, achieving good control until recently. He maintained an active lifestyle, cycled regularly, ate well, and lacked common risk factors like obesity or a history of smoking. Work was stressful, but no more than usual.

Despite doing everything he was supposed to be doing, his blood pressure remained elevated. His primary care provider adjusted his medications, but nothing seemed to work. “I started to have symptoms from the high blood pressure, and I knew I needed to do something different. It was a generalized, vague internal pressure. I felt like I was going to explode,” said David.

Nearly 50% of all U.S. adults have hypertension, and only one in four has it under control. For a subset of patients like David, standard hypertension medications prove ineffective, leading to what’s known as resistant hypertension. With blood pressure that remains dangerously elevated despite the use of three or more drugs, these individuals face an increased risk of heart disease, stroke, and cardiovascular complications.

Following the advice of a colleague, David consulted Anna Krawisz, MD, lead cardiologist at the Complex Hypertension Clinic at Beth Israel Deaconess Medical Center (BIDMC). Established in 2023 by Jennifer Cluett, MD, and Dr. Krawisz, the clinic offers evaluation and personalized treatment for patients with uncontrolled hypertension. The multidisciplinary team includes specialists from cardiology, endocrinology, nephrology, and other fields, providing a comprehensive approach to care.

“When I started working with David, we first ruled out underlying medical conditions to try to uncover clues to what was causing his elevated pressures,” said Dr. Krawisz. “After adjusting his medications, we then considered a novel therapy to complement his treatment.”

Renal denervation (RDN), a minimally invasive procedure, wasn’t a cure, but it might help. Pioneered by Eric Secemsky, MD, at BIDMC, RDN involves disrupting the nerves controlling the kidneys’ arteries, potentially bringing treatment-resistant hypertension under control. “Our clinic has been at the forefront of this technology,” said Dr. Secemsky, Director of Vascular Intervention at BIDMC and Section Head of Interventional Cardiology and Vascular Research at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at BIDMC.

David wasn’t familiar with the procedure, but after researching, he found that RDN has a good safety profile. Dr. Secemsky has performed a high volume of cases and been involved in research and monitoring results, which was reassuring. The Smith Center created an RDN Registry and is collaborating with the American College of Cardiology to enable research and analysis of real-world data, disease progression, and outcomes for patients undergoing renal denervation.

“It’s important to me as a patient to have a clinician skilled at patient care and research. It’s a really nice balance with the team at BIDMC. It’s good for me and patient care as a whole,” added David. He underwent the procedure as an outpatient and resumed normal activities within about a week.

A year later, while still on multiple medications, his blood pressure is now in a normal range. He used to dread taking his blood pressure twice a day — and now he does it with a sense of confidence. The experience gave him a new perspective on how he practices medicine and cares for himself. Outside of work, he recently celebrated his son’s 30th birthday, is planning a trip to Mexico City in the fall, and is looking forward to a family wedding next year.

“When, as a physician, you feel out of control in your own health, you feel very vulnerable and that you can’t provide the necessary care for your patients. I’m grateful I found Dr. Krawisz and the team at BIDMC. Working with them, I was able to regain control of my blood pressure and my overall health and well-being. Without them, I think I would still be struggling.”