New approaches to blood pressure problems

Written by: Professor Melvin Lobo
Published: | Updated: 02/10/2020
Edited by: Jay Staniland

Hypertension, or high blood pressure doesn’t usually have noticeable symptoms. Blood pressure is recorded by the systolic pressure which is the pressure your heart pumps blood around the body, and the diastolic pressure which is the resistance to blood flow in the vessels.

High blood pressure is usually considered to be 140/90 mm Hg or higher. Ideal blood pressure is less than 130/80 and low blood pressure is below 90/60.

High blood pressure can lead to conditions such as:

  • Heart disease: e.g. heart attacks or heart failure.
  • Stroke
  • Kidney disease and kidney failure leading to dialysis

Drug intolerant hypertension


Some patients can suffer side-effects from anti-hypertensive drugs such as nausea and severe lethargy. These patients can be challenging to manage as they are poorly understood and there is little experience of how to get around the intolerances.

Professor Lobo has formulated new medicinal approaches to these problems, such as the use of liquid formulations and patches. Following this, device therapy can be adopted for some patients.


Blood pressure monitoring


New approaches to blood pressure monitoring, include 24 hour ambulatory blood pressure monitoring, to determine if the patient is truly hypertensive, to monitor if the treatments are working, and to judge the seriousness of the hypertension.

This method is the most reliable guide to prognosis, however the traditional way of fitting the patient with a cuff can cause considerable inconvenience to patients.

To overcome this, Professor Lobo now uses a small wristwatch-like device, which is more comfortable for the patient and does not disturb sleep. This helps to give much more accurate readings.


High blood pressure – new treatments in resistant hypertension


When medication has little or no effect on the patient, the next step is to adopt novel therapeutic approaches to treatment. Clinical trials being undertaken by Professor Lobo include renal denervation, central iliac arteriovenous anastomosis, carotid sinus stimulation and carotid body ablation. These technologies are in the experimental stage, and the results are yet to be fully understood.

By Professor Melvin Lobo
Internal medicine

During the coronavirus pandemic, Professor Lobo is aware that many patients have concerns about hypertension, their medications and the risk of COVID-19. As such there are two things to be aware of:
1. The following link will give you free access to trustworthy information on these issues from the International Society of Hypertension which is available to all-comers:
2. Please be aware that ALL insurers are currently covering as usual for remote consultations and Professor Lobos continues to run virtual clinics by telephone to provide ongoing care for his patients whilst also contributing to the NHS frontline at the Royal London Hospital in Whitechapel. It may be possible to also have video calls.

Professor Melvin Lobo is a pioneering cardiovascular physician and clinical hypertension specialist, based in London. He is renowned for his work as a specialist in all forms of blood pressure disorders, and has been involved in a number of key clinical studies of device-based therapies for these conditions. He is an internationally recognised specialist in hypotension (low blood pressure) and highly variable BP disorders and circulatory conditions including PoTS and fainting disorders. His group has been involved in novel treatments (some first in man) to help patients with these diagnoses. To assist with the diagnosis and management of complex circulatory conditions, he set up the Barts Autonomic Laboratory in 2012 staffed with experts in neurophysiology and haemodynamics.

Professor Lobo is director of the renowned Bart's Blood Pressure Clinic in London, which has been recognised as a Hypertension Centre of Excellence by the European Society of Hypertension. The centre has become the premier UK centre for trials of device-based therapy of hypertension. He is a specialist advisor to NICE on interventional therapy of hypertension, and has authored UK and European guidance on renal denervation. Dr Lobo is an NHS Professor in Cardiovascular Medicine at Bart's and the London School of Medicine and Dentistry, and has contributed to a number of peer-reviewed articles for medical journals and medical textbooks.

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Overall assessment of their patients

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