2013 Nahum J. Winer Lecture - Unresolved Issues in Diagnosing and Treating Hypertension: Is Renal Sympathectomy An Answer?

NYAM is pleased to welcome Michael A. Weber, MD as the 2013 Nahum J. Winer Lecturer.
By current consensus definitions, "hypertension", or high blood pressure, affects a third of all adults in the United States, and well over half of all people aged over 60. But despite the fact that it is the most common chronic condition treated by clinicians, big questions still remain. At what level of blood pressure should we diagnose hypertension and how aggressively should we treat it? Can we choose any available drug to reduce blood pressure, or are some drugs better at preventing the heart attacks, strokes and mortality associated with hypertension? These questions have been the subject of intensive deliberations by expert committees during the past 5 years, but there is still not sufficient evidence to provide authoritative guidance for the diagnosis of hypertension or for optimal care of many patients affected.

These issues, and the underlying data, are appropriate for review. Moreover, treating hypertension can be difficult; there is currently a strong interest in so-called treatment-resistant hypertension, which does not respond to the usual drug therapy. Should physicians keep adding more drugs to try and get blood pressure below some arbitrarily defined goal, or should they turn to new (not yet FDA-approved) procedures such as renal sympathectomy? This technique destroys the nerves serving the kidneys, important in blood pressure control, by using a catheter to apply an electric current through the arteries that supply the kidneys. This method, although invasive, appears to be effective in many patients whose blood pressures cannot otherwise be controlled. Major clinical trials are now underway to examine this treatment more completely.

These issues, i.e., blood pressure levels appropriate for treatment, currently proposed drug strategies, and the possible place of renal sympathectomy, will be reviewed in this lecture.

Michael A. Weber, MD is Professor of Medicine at the SUNY Downstate College of Medicine in Brooklyn, New York. He received his medical degree from Sydney University in Australia.

His career has been focused primarily on hypertension and preventive cardiology. He has published numerous research articles in the medical literature and has authored or edited 16 books. Together with Dr. Suzanne Oparil, he is responsible for the widely used reference volume, Hypertension.

Dr. Weber is the Editor-in-Chief of The Journal of Clinical Hypertension. Dr. Weber was one of the founders of The American Society of Hypertension and has served as its President. He also served as Chair of the ASH Hypertension Specialists Program. He is a Fellow of The American College of Physicians, The American College of Cardiology and The American Heart Association. He has served on the Cardiovascular and Renal Drugs Advisory Board of the Food and Drug Administration, and continues as a consultant to that Agency. He has also served for ten years as Chairman of the Formulary Committee of a major pharmacy benefits provider serving many of the leading health plans in the United States.

His main current research interests are in clinical trials of patients at high risk of cardiovascular events or strokes. He is also participating actively in trials in patients with metabolic disorders such as diabetes and kidney disease. Dr. Weber currently serves on the Steering Committees of several national and international clinical outcomes trials.