South Florida Hospital News
Monday August 19, 2019

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August 2019 - Volume 16 - Issue 2




UHealth's New Hypertension Clinic Offers In-Depth Screening for Stroke and Cardiac Risk

Dr. Delgado testing the equipment.

The University of Health System’s new Hypertension Clinic provides in-depth screening and personalized treatment for high blood pressure, the number one risk for heart attack and stroke, the leading causes of death in the United States.
“About 45 percent of U.S. adults have high blood pressure, but many don’t realize it until they show up in the emergency room,” said Maria Carolina Delgado-Lelievre, M.D., assistant professor of medicine. “Hypertension also runs in families, so it’s important for children and grandchildren to be screened, as well as adults.”
Dr. Delgado-Lelievre launched the Hypertension Clinic in April as part of her Hypertension and Cardiovascular Prevention Program, a collaborative effort with UHealth’s new Preventive Cardiovascular Medicine Program. Clinic appointments are available Thursdays and Fridays from noon to 6 p.m.
“Given the harmful effects of hypertension, the clinic has become a resource for physicians who refer their patients to the clinic for comprehensive screening that can provide information that otherwise might not be detected until after a stroke or major cardiac episode,” said Dr. Delgado-Lelievre
Increasing Awareness
Hypertension remains largely a problem of awareness, treatment and control, according to Dr. Delgado-Lelievre. A heart attack or stroke can happen without warning, and many patients are unaware they have high blood pressure. Sadly, and often too late, it is at this point that patients become aware that they suffer from hypertension. According to the U.S. Centers for Disease Control and Prevention, 77 percent of first-time patients who have a stroke and 69 percent who have a heart attack were already suffering from hypertension and didn’t know it.
“Hypertension itself causes no symptoms,” said Dr. Delgado-Lelievre. “If hypertension had symptoms, a patient’s ability to know that something was wrong would be greater, and he or she would be more able to take preventive action, rather than react after an incident.”
The American Heart Association/American College of Cardiology recently published new guidelines indicating that elevated blood pressure occurs at levels above 120/80 mmHg. The high number is systolic blood pressure, when the heart is pumping blood, while the low number is diastolic blood pressure, when the heart relaxes so it can be filled with blood again.
“With these changes, nearly half of U.S. adults are now considered to have high blood pressure,” said Dr. Delgado-Lelievre. “It’s a chronic condition that starts early in childhood as a progressive malfunction of your arteries that can lead to heart attack or heart failure, stroke, kidney disease, aneurysms, eye damage and cognitive impairments. “Many older adults who are concerned about facial wrinkles or erectile dysfunction may not realize that hypertension may be contributing to those issues,” she added.
While most adults are used to getting their blood pressure measured during a physician visit, Dr. Delgado-Lelievre said, it’s a mistake to think of hypertension as a static number.
“Your blood pressure can change dramatically during the day, depending on factors like stress, exercise or body position,” she said.
In-Depth Screening
As part of its in-depth screening service, the Miller School’s Hypertension Clinic team can create a hemodynamic profile that shows the curve of an individual’s blood pressure as the heart beats.
“Think about how a wave on the ocean crashes on the shore and then goes back to the sea,” said Dr. Delgado-Lelievre. “Your heart pumps out blood, but if there is resistance, the pressure builds up and the heart has to work harder to override that pressure. The hemodynamic profile helps the patient understand that high blood pressure is more than a number; it is a systemic disease that affects the whole body.”
Hypertension screening may also include a stress test of the endothelium, the cells that line the interior surface of blood vessels. This typically involves holding a hand grip for one minute while the heart pumps. In a patient with no risk for hypertension, the stress test will cause the blood pressure to decrease; however, in hypertensive patients, and in patients with normal blood pressure but a family history of high blood pressure, the blood pressure might shoot up during the stress test. This test can detect early vascular dysfunction in subjects who are not yet diagnosed with high blood pressure.
Dr. Delgado-Lelievre says blood pressure has a genetic component, and someone whose parent or grandparent had hypertension is at greater risk for the disease.
“If even just one grandparent has a history of hypertension, the likelihood is that the next generations will carry the risk and become hypertensive in the future,” she said. “Parents need to be aware of the importance of screening children at an early age in order to reduce the potential vascular damage.”
Treating Hypertension
Dr. Delgado-Lelievre says treatments for hypertension need to be personalized for each patient.
“Some people need aggressive care involving medications and lifestyle changes because the cardiovascular risk is high,” she said. “Other patients may benefit from lower doses of medication. However, they should still be monitored frequently, particularly if several drugs are involved.”
Clinic patients are given a 24-hour blood pressure monitor to wear at home and record the results.
“I ask our patients to email me a report of their blood pressure, as well as when they take their medication,” Dr. Delgado-Lelievre said. “It’s very important to have follow-up visits every few weeks until an individual’s blood pressure is brought under control.”
Before joining the Miller School in January, Dr. Delgado-Lelievre had focused her research and clinical services on hypertension for 10 years at the University of Michigan. She earned her medical degree at the University of Carabobo, Venezuela, and performed her medicine residency both at the University of Carabobo and at UM Jackson Memorial Hospital. She also performed clinical and research fellowship in hypertension and cardiovascular medicine at the University of Michigan.
Because of her groundbreaking research, Delgado-Lelievre has earned a reputation as one of the country’s experts in understanding the role of intracellular potassium in cardiovascular disease. She is known to be the first to describe low intracellular potassium as an intermediate phenotype for hypertension. Her research efforts have earned her numerous grants and awards, including the American Heart Association Samuel A. Levine Young Clinical Investigator Award, the AHA Wyeth-Ayerst Women in Cardiology Award, and the American Society of Hypertension’s Bristol-Myers Squibb Recognition Award for Young Investigators.
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