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Stanford Health Care

Diagnosis

How We Can Help You 

Sometimes, your blood can push too forcefully against your arteries as your heart pumps. If that happens, it could be a sign of high blood pressure or hypertension. You should see a specialist as hypertension can cause heart and blood vessel problems, and be difficult to control.

Our doctors regularly care for challenging cases of resistant hypertension. Our team has the expertise to determine whether lifestyle changes and medications can help protect your health. We also explore new options for treating hypertension that has not responded to existing treatments.

We primarily provide care for resistant hypertension through the Hypertension Center.

WHAT WE OFFER YOU FOR RESISTANT HYPERTENSION

  • Nationally recognized expertise in treating resistant hypertension and minimizing the harm it causes.
  • Precise diagnosis to identify the type and root causes of your hypertension, including advanced home monitoring devices to track your blood pressure over a longer period of time.
  • Team-based planning for challenging cases that brings together experts in nephrology, cardiology, endocrinology, neurology, radiology, sleep medicine and surgery to tailor care to your type of hypertension.
  • Advanced treatment for resistant hypertension, including a thorough reevaluation of your existing care plan, medication and lifestyle changes, and new minimally invasive treatments.
  • Dedicated follow-up care to support your treatment and help keep your blood pressure in check.
  • Comprehensive support services to help you cope with your diagnosis, including stress reduction, dietary counseling, exercise recommendations, and other assistance.
  • Active clinical research and trial program to evaluate the risk factors for developing resistant hypertension and advancing new treatments, including renal denervation and new minimally invasive treatments.

Treatment for Resistant Hypertension

Our specialized doctors spend the time to understand why you have high blood pressure and how it affects your health. We may discover that we can effectively treat you with established treatment approaches. For hard-to-treat conditions, we go beyond the standard care to find an appropriate treatment.

Medication

Upon evaluation for resistant hypertension, medication will be reassesed and surgery may be considered, depending on results from diagnostic tests. 

Lifestyle

Changes may be recommended in order to reduce overall hypertension. This would include watching your diet and keeping sodium intake low, keeping a home blood pressure log, attending educational workshops, reducing or managing stress, limiting alcohol consumption, giving up smoking. 

Renal Denervation

Renal denervation is a new treatment for resistant hypertension that targets the nerves near the kidneys responsible for regulating blood pressure. Surgeons once attempted to relieve hypertension by severing these renal artery nerves, which resulted in lowering blood pressure too far.

By contrast, renal denervation silences a few, targeted nerves to restore healthy blood pressure. It does so with heat energy delivered by a catheter, a thin tube threaded through an artery. This minimally invasive procedure is currently in clinical trials at medical centers nationwide. Our program is the only West Coast participant in this trial. 

We take a personalized approach to treat patients with severe or refractory hypertension, and evaluate them for potential secondary or reversible forms of high blood pressure.

 

 

Clinical Trials

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Open Clinical Trials

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Clinical trials evaluate new medical approaches, devices, drugs, and other treatments. As a Stanford Health Care patient, you may be eligible to participate in open clinical trials.

Open trials refer to studies currently recruiting participants or that may recruit participants in the near future. Closed trials are not currently enrolling, but similar studies may open in the future.

 

View Closed Clinical Trials for Diagnosis
Make An Appointment

To schedule an appointment with a cardiac specialist, call 650-723-6459. 

To schedule an appointment with a hypertension specialist, call 650-723-6961.

What Is Resistant Hypertension?

Screenings and Diagnostics for High Blood Pressure

To determine why your blood pressure is high and how to treat it, we monitor how it can vary throughout your day.We may ask you to take a small, portable blood pressure recorder home to measure your condition around the clock, especially if we suspect that your blood pressure changes when you come for appointments.

Learn about other screenings, tests and imaging services we may also use to determine your condition.

Screenings
  • Screening: for signs of kidney dysfunction contributing to high blood pressure including blood and urine tests.

  • Blood and urine studies: for signs of disorders of the endocrine system, including primary and secondary forms of hyperaldosteronism, thyroid disease, hypercortisolism, pheochromocytoma, and hyperparathyroidism.

  • 24-hour urine studies: for offering precise measurement of dietary sodium intake, and evaluation of hormones to detect endocrine tumors or disorders that may be the underlying cause of hypertension.

  • Toxicology screens: for substances that contribute to hypertension and provide a picture of medication compliance.
Diagnostic Tests
  • Ambulatory Blood Pressure Monitoring: a device worn for 24-48 hours on the upper arm to record blood pressure at home during the day and night to classify different forms of elevated blood pressure including paroxysmal, labile, white-coat, masked, and nocturnal hypertension.

  • Adrenal Vein Sampling: a procedure conducted by our interventional radiologists to assess lateralization of adrenal hormone (e.g. adrenal or cortisol) secretion; identifies candidates for surgical treatment of hypertension.

  • Renal Vein Renin Sampling: a procedure conducted by our interventional iadiologists to asses lateralization of renin production; confirms existence of rare renin-producing tumors. 

  • Captopril Suppression Test: offering biochemical confirmation of excess aldosterone production, a hormone that causes high blood pressure.

  • Autonomic Testing: a procedure performed by our Neurology colleagues to assess for autonomic nerve disorders that lead to conditions such as labile hypertension, orthostatic hypertension, or orthostatic hypotension.

  • Polysomnography (Sleep Studies): an overnight procedure assessing the degree of obstructive or central sleep apnea that can cause and/or exacerbate resistant hypertension. Our patients are formally evaluated by our sleep medicine specialists before and after polysomnography. If a device is recommended to treat sleep apnea, we also follow-up to evaluate the efficacy of the device.
Imaging
  • Abdominal CT: We offer computer tomography scans of the abdomen with thin cuts through the adrenal glands to assess for adenomas, and we offer angiograms for visualization of renovascular disease.

  • Renal ultrasound: Both colleagues in Diagnostic Radiology and Vascular Surgery offer doppler of the renal arteries as a screening test for renovascular disease such as fibromuscular dysplasia or atherosclerotic renal artery stenosis.

  • Magnetic Resonance Imaging (MRI/MRA) of the abdomen: High-density MRI of the adrenal glands, kidneys, and renal arteries. Our multidisciplinary team has developed an innovative protocol for abdominal imaging. This novel approach has detected adrenal tumors and renal abnormalities missed on outside imaging.
Genetic Testing
  • Genetic testing: for familiar causes of monogenic hypertension include glucocorticoid-remediable hyperaldosteronism and syndromes of apparent mineralocorticoid excess.

  • Genetic counseling services and whole exome sequencing are also available through Stanford's Clinical Genomic Service.

Our Clinics

Hypertension Center

The Stanford Hypertension Center provides comprehensive and innovative care for patients with severe or refractory hypertension, including evaluation for secondary and reversible forms of hypertension.

Hypertension Center
300 Pasteur Drive
 1st Floor, Suite A11
 Stanford, CA 94305
Phone: 650-723-6961 Getting Here
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