The Curbsiders Internal Medicine Podcast | MedEd | FOAMed | Internist | Hospitalist | Primary Care | Family Medicine
#77: Hypertension Guidelines Showdown
Manage episode 195321736 series 1345893
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.
- 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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