Center of Excellence
Complex Hypertension
Program Overview
Our mission is to integrate the latest advances, latest research, and best practices in the diagnosis and management of hypertension using a multi-disciplinary approach with a personalized patient care experience.
Program Overview
In collaboration with the NCH Cardiovascular Prevention Program, the Comprehensive Hypertension Clinic supports patients whose blood pressure remains uncontrolled despite medications and lifestyle changes. Uncontrolled hypertension increases the risk of heart attack, stroke, kidney disease, and other life-threatening complications.
Our team uses advanced diagnostics, evidence-based practices, and emerging treatment approaches to identify underlying causes and develop personalized care plans based on each patient’s condition and risk factors.
What Is Complex Hypertension?
Complex hypertension refers to high blood pressure that is difficult to manage using standard treatments and is often referred to as resistant hypertension, meaning blood pressure remains above goal despite the use of multiple medications. It typically involves one or more of the following:
- Blood pressure that remains elevated despite taking three or more medications, including a diuretic
- Diagnosis at a younger age, often under 40
- Underlying conditions such as kidney disease, hormonal disorders, or sleep apnea
Unlike routine hypertension, these cases require specialized evaluation to identify contributing factors and guide treatment.
Treatments & Procedures
At the NCH Rooney Heart Institute, our Complex Hypertension Center of Excellence offers a comprehensive, coordinated approach to evaluating and managing complex hypertension. Procedures and Treatment Approaches:
- Advanced treatment options, including renal denervation for appropriate patients
- Personalized medication optimization
- Lifestyle and risk-factor management
Care Model:
- Multidisciplinary care across cardiology, nephrology, endocrinology, and sleep medicine
Diagnostics and Evaluation:
- 24-hour ambulatory blood pressure monitoring
- Renal imaging and hormone testing
Our goal is to identify the underlying causes of elevated blood pressure and provide care tailored to each patient to help protect long-term cardiovascular, kidney, and overall health.
Conditions We Treat
Many patients are referred after presenting with uncontrolled blood pressure or signs of secondary hypertension.
In addition to managing complex and resistant hypertension, our team evaluates related cardiovascular conditions that may contribute to or result from long-standing high blood pressure.
- Resistant hypertension
- Hypertensive heart disease
- Cardiac amyloidosis
- Atrial fibrillation
- Secondary hypertension (including renal artery stenosis, adrenal disorders, and sleep apnea)
- Coronary artery disease
- Structural and valvular heart disease
- Patent Foramen Ovale (PFO)
Testing & Diagnostics
We provide a comprehensive range of diagnostic services to identify underlying causes, assess cardiovascular risk, and guide personalized treatment decisions, including:
- 24-hour ambulatory blood pressure monitoring
- Renal Doppler ultrasound
- CT and MR angiography
- Adrenal vein sampling
- Quantitative echocardiography
- Carotid Doppler
- Autonomic function testing
- Exercise stress testing
- Ankle-brachial index
- Renal vein renin sampling
Additional services may include:
- Sleep lab evaluations
- Genetic and biochemical profiling
- Cardiac imaging and catheterization
- Electrophysiology studies
- Cardiovascular risk calculators and education tools
