#77 Hypertension Guidelines Showdown

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.8 • 3.1K Ratings

🗓️ 8 January 2018

⏱️ 75 minutes

🔗️ Recording | iTunes | RSS

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Summary

Ease the tension around blood pressure goals in older adults and get inside the hypertension guidelines released by the ACP and ACC/AHA in 2017 with the sagacity of Dr. Mary Ann Forciea, MD, MACP, Professor of Medicine at University of Pennsylvania. We cover: how to properly measure blood pressure, how to diagnose hypertension, blood pressure targets, why BP goals differ by society, how to guidelines are written and how to interpret them with a critical eye, plus a hot take on the 2017 ACC/AHA guidelines. Dr. Shreya Trivedi joins as cohost. Special thanks to Hannah Abrams for her wonderful infographics and to Dr Trivedi for compiling our show notes.

Time Stamps

00:00 The setup
02:15 Disclaimer
03:32 Picks of the Week
08:13 Getting to know Dr Forciea
13:35 Broad overview and a clinical case of geriatric hypertension
14:45 Brief history on BP targets
18:05 How do you measure a blood pressure? What type of monitors are available?
22:13 How to standardize BP in the office?
23:55 Ambulatory BP monitoring
24:55 Home blood pressure monitoring
26:11 Standing blood pressure readings and orthostatic hypotension
27:53 How guidelines are written
30:51 Evaluating evidence quality and strength of recommendation
32:35 Timeline and process for guideline generation
34:27 How to read guidelines with a “critical eye”
36:15 Return to our case of uncontrolled hypertension
38:25 Blood pressure targets from ACP guidelines and BP management in frail older adults
40:33 Counsel patients on BP targets
42:25 Low diastolic blood pressure
45:35 SPRINT and the ACP BP guidelines
48:58 Take home points from Dr Forciea
50:07 HTN targets and pay for performance in clinical practice
51:45 Curbsiders recap the ACP guidelines
53:45 Matt and Paul recap the AHA guidelines
54:47 AHA definitions of hypertension
56:15 Diagnosing hypertension and how to measure a blood pressure
60:35 Choosing a blood pressure monitor and HBPM
62:29 Blood pressure goals in ACC guidelines
66:08 Non-pharmacologic measures
69:15 Will we follow these new strict targets?
72:45 Outro

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Transcript

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0:00.0	This is Matt and I wanted to give a little backstory before we get into this much weighted
0:09.0	episode, at least for me.
0:12.4	We had recorded with Dr. Forcia, I believe it was the end of September and at that time
0:17.9	learned that the ACC AHA guidelines on hypertension would be coming out.
0:24.3	Now we were talking with Dr. Forcia, she is one of the writers of the ACP 2017 guidelines
0:30.4	for the pharmacologic treatment of hypertension in adults aged 60 years or older.
0:35.6	And so we talked to her about those guidelines and a bit about how to treat and how to approach
0:39.8	hypertension in older adults and how guidelines are written.
0:44.1	Then the ACC AHA released their guidelines before we could release this episode, which
0:49.5	basically forced us to have an emergency recording session.
0:53.9	So the first 50 minutes of this episode are what we had planned to record with Dr. Forcia.
1:01.8	And the last 20 minutes of this episode are kind of going back to episode number two,
1:06.1	where it was just me and Paul Williams having a discussion about the sprint trial.
1:10.2	This is me and Paul Williams having a discussion about the 2017 ACC AHA guidelines.
1:17.3	I think you're going to find this episode very timely and relevant to your clinical practice.
1:22.7	And hopefully it will help you interpret guidelines because as a generalist, I feel that is a
1:29.3	difficult thing when you have multiple societies telling you different things.
1:33.8	And I think this episode came out really interesting because I think Dr. Forcia is somewhat
1:38.8	of a pre-cog to reference minority report because she sort of predicted that the guidelines
1:45.1	would differ from the ACP guidelines.
1:47.8	And the things that she talked about, I thought were really illustrative of some of the differences
1:54.9	between the ACC AHA guidelines and why those differences exist.
	...

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