The Department of Nephrology and Hypertension within Cleveland Clinic’s Glickman Urological & Kidney Institute has a rich history of innovation and research in hypertension. The department’s Center for the Study of Blood Pressure and Fluid/Electrolyte Disorders provides specific expertise in these areas, and is staffed by American Society of Hypertension (ASH) certified hypertension specialists, with lab with space and equipment dedicated to hypertension evaluation and testing.
Besides the standardized use of automated blood pressure devices in our outpatient clinics, we have a large cohort of patients who undergo 24-hour ambulatory blood pressure measurements to help with diagnosis of white coat hypertension, masked hypertension, labile hypertension, and assessment of nocturnal dipping and efficacy of therapy. We also use non-invasive hemodynamic testing with impedance cardiography to help guide treatment decisions and tailor therapy by assessing neuro-humoral profiles and hemodynamic parameters in our hypertension lab. Central blood pressures have been shown to correlate more strongly with vascular disease than routine peripheral blood pressure measurements, and we assess central blood pressure indices using applanation tonometry, including pulse wave analysis and pulse wave velocity. We also have the capability to study endothelial function non-invasively, which could help early detection of endothelial dysfunction for assessment of cardiovascular risk.
The Center has expertise in the field of secondary hypertension management, specifically related to the diagnosis and management of primary hyperaldosteronism, pheochromocytoma, and renal artery stenosis; as well as electrolyte disorders.
Symplicity HTN-3 renal denervation trial
Hyperactivation of the sympathetic nervous system has a major role in the initiation, development and maintenance of hypertension. In prior studies, patients undergoing selective renal denervation to attenuate sympathetic tone have been reported to have significant blood pressure reduction which is sustained over at least a two-year period. The Departments of Nephrology and Hypertension and Cardiology at Cleveland Clinic are currently enrolling patients in the SYMPLICITY HTN-3 trial, which is the first trial in US examining this novel therapy. SYMPLICITY HTN-3 eligibility criteria include a systolic blood pressure of greater than 160 mm Hg and taking at least three antihypertensives (one of which must be a diuretic).
The Department of Nephrology and Hypertension is involved in the NIH SPRINT (Systolic Blood Pressure Intervention Trial) to determine whether or not treating systolic blood pressure aggressively will reduce the rate of heart disease and stroke, memory decline or worsening of kidney disease in adults over the age of 55 who already have high blood pressure, with participants followed long-term up to 7 years.
CORIN Hypertension Gene study
Cleveland Clinic scientists have discovered an enzyme in the heart that controls blood pressure and is encoded in the CORIN gene. Lack of this enzyme or a variation in the CORIN gene may cause hypertension in patients. This discovery may lead to improved screening for hypertension and heart disease, as well as a more targeted approach and treatments for individuals with a deficiency in the CORIN gene.