Letter to the Editor

Effect of a Multidisciplinary Clinic for the Treatment of Refractory Hypertension

Authors: Javed M. Nasir, BS, Steven J. Durning, MD, Kevin A. Dorrance, MD, G Dodd Denton, MD, MPH

Abstract

Multiple reasons exist for hypertension to be resistant to medical therapy. Since multidisciplinary clinics have been shown to be effective for treating many chronic disorders, such as diabetes mellitus, heart failure, pain, asthma, rheumatoid arthritis, and HIV,1,2 we created a multidisciplinary clinic dedicated exclusively to the treatment of refractory hypertension, defined as blood pressure >140/90 despite prescription of three antihypertensive medications. This clinic included a nutritionist, a pharmacist, an internist with expertise in hypertension, a nurse practitioner with expertise in hypertension, and a registered nurse.

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References

1. Maislos M, Weisman D. Multidisciplinary approach to patients with poorly controlled type 2 diabetes mellitus: a prospective, randomized study. Acta Diabetol 2004;41:44–48.
 
2. Martineau P, Frenette M, Blais L, et al. Multidisciplinary outpatient congestive heart failure clinic: impact on hospital admissions and emergency room visits. Can J Cardiol 2004;20:1205–1211.
 
3. Psaty BM, Manolio TA, Smith NL, et al, Cardiovascular Health Study. Time trends in high blood pressure control and the use of antihypertensive medications in older adults: the Cardiovascular Health Study. Arch Intern Med 2002;162:2325–2332.
 
4. Psaty BM, Lumley T, Furberg CD, et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA 2003;289:2534–2544.
 
5. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288:2981–2997.
 
6. Chobanian AV, Bakris GL, Black HR, et al, National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 Report. JAMA 2003;289:2560–2572.