Episode #369: The 2025 Blood Pressure Update
Barbell Medicine Podcast
Barbell Medicine
4.8 • 1.2K Ratings
🗓️ 7 October 2025
⏱️ 70 minutes
🧾️ Download transcript
Summary
The old rules for blood pressure are changing. In this episode, we break down the critical 2025 updates that are reshaping how we diagnose and manage hypertension. We move beyond the simple 120/80 cutoff to explore a new risk-based approach, updated ACC/AHA guidelines pushing for lower targets, and new recommendations to screen for the "silent epidemic" of primary aldosteronism. Plus, we cover why low-dose combination therapy is the new standard for treatment and take a realistic look at the new Apple Watch hypertension detection feature.
Become a Barbell Medicine Plus Member Today
Timestamps:
- (01:45) Moving Beyond Binary Cutoffs: Why cardiovascular risk is a continuous spectrum and how the diagnostic approach is shifting from a single number to a person's absolute CVD risk.
- (10:15) The New 2025 ACC/AHA Guidelines: We break down the updated targets, including the push for systolic blood pressure below 120 mmHg and new treatment thresholds based on the PREVENT risk calculator.
- (30:15) The "Silent Epidemic" - Primary Aldosteronism: Learn why new guidelines suggest screening all individuals with hypertension for this common but often-missed condition that significantly increases cardiovascular risk.
- (40:10) Smarter Treatment Strategies: An analysis of new data showing that starting with multiple medications at lower doses is more effective and has fewer side effects than traditional monotherapy.
- (48:30) How Often to Check Your BP at Home: For stable patients, monitoring too frequently can be misleading. We discuss the optimal interval for re-testing to avoid acting on statistical "noise".
- (58:15) The Apple Watch Hypertension Feature: Is it a helpful tool or just hype? We review Apple's data on its accuracy, including its low sensitivity (41.2%) and high specificity (92.3%), and discuss its best use case.
References
- https://www.acc.org/Latest-in-Cardiology/Journal-Scans/2025/08/28/16/33/New-Scientific-Statement-Deep-Dives
- https://pubmed.ncbi.nlm.nih.gov/40825202/
- https://www.acpjournals.org/doi/10.7326/ANNALS-25-02804
- https://www.jacc.org/doi/10.1016/j.jacc.2025.08.047
- https://www.jacc.org/doi/10.1016/j.jacc.2025.05.002
- https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.125.25466
- https://academic.oup.com/jcem/article/110/9/2453/8196671?login=false
- https://www.acpjournals.org/doi/10.7326/ANNALS-24-03153
- https://www.acpjournals.org/doi/10.7326/ANNALS-25-01368
- https://pubmed.ncbi.nlm.nih.gov/37439256/
- https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066389
- https://academic.oup.com/ajh/article/35/12/967/6620780.
- https://www.mdcalc.com/calc/10491/predicting-risk-cardiovascular-disease-events-prevent
- https://pubmed.ncbi.nlm.nih.gov/40324193/
- https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00991-2/abstract
- https://www.bpmodel.org/
- https://journals.lww.com/jhypertension/fulltext/9900/how_often_should_self_monitoring_of_blood_pressure.736.aspx
- https://www.apple.com/health/pdf/Hypertension_Notifications_Validation_Paper_September_2025.pdf
Resources Page: https://www.barbellmedicine.com/resources/
Template Quiz: https://www.barbellmedicine.com/template-quiz/
Got pain and need a professional who understands you lift? Or, do you need an experienced coach to help you get the most out of your training? Contact us at [email protected]
Our Sponsors:
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Factor: https://factormeals.com/bbm50off
* Check out Rosetta Stone and use my code TODAY for a great deal: https://www.rosettastone.com
Support this podcast at — https://redcircle.com/barbell-medicine-podcast/donations
Advertising Inquiries: https://redcircle.com/brands
Privacy & Opt-Out: https://redcircle.com/privacy
Transcript
Click on a timestamp to play from that location
| 0:00.0 | Welcome back to the Barbell Medicine Podcast, where we bring modern medicine to |
| 0:03.2 | strength conditioning and strength and conditioning to modern medicine. |
| 0:05.6 | I'm your host, Dr. Jordan Feigenbaum, and it's time to talk about blood pressure once again |
| 0:10.1 | and why almost everything you knew is changing. |
| 0:13.7 | Think of it. |
| 0:14.2 | When was the last time a simple number could label you with a lifelong disease? |
| 0:18.5 | For decades, medicine has used a single binary threshold for conditions like high blood |
| 0:23.0 | pressure or hypertension. |
| 0:24.8 | But we now know that cardiovascular risk is a continuous spectrum, not a simple on-off switch. |
| 0:30.6 | And today, we're diving into a new risk-based approach that's used to diagnose high blood pressure, |
| 0:36.1 | finally moving past those old rigid |
| 0:38.0 | cutoffs. We'll also break down the updated 2025 American College of Cardiology and American Heart |
| 0:43.3 | Association guidelines that are pushing for a lower blood pressure goal for most adults based on the |
| 0:48.1 | latest evidence, but that's not all. We'll cover the condition that's often called the silent |
| 0:53.1 | epidemic of hypertension, a condition called primary aldosteroneism, and why new guidelines now suggest screening all individuals with high blood pressure for this common yet often misdiagnosis. |
| 1:04.0 | Plus, we'll look at the latest data on drug efficacy, how often you should be checking your home blood pressure if you're monitoring it on your own, and will even weigh in on the effectiveness of the new Apple Watch hypertension detection feature. Ready to get the updated facts that could change how you practice and how you train. Let's dive in. But first, we have to introduce the second most handsome doctor in North America. Dr. Austin Baraki. What's going on, dude? Hey, excited. you know, this is an area that people have paid attention to for a long time, but man, |
| 1:31.8 | the past few months slash year or so of new publications and guidelines and research coming |
| 1:37.2 | out, it just accumulated to a point where I was like, dude, we need to do a kind of a comprehensive |
| 1:43.3 | update because some of the ways that I even practice |
| 1:46.1 | and how I assess and manage patients has been directly impacted by much of this in the past year. |
| 1:51.7 | So yeah, looking forward to it. |
| 1:53.2 | Yeah, as you said off air, blood pressure is life. |
... |
Please login to see the full transcript.
Disclaimer: The podcast and artwork embedded on this page are from Barbell Medicine, and are the property of its owner and not affiliated with or endorsed by Tapesearch.
Generated transcripts are the property of Barbell Medicine and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.
Copyright © Tapesearch 2025.