The Curbsiders Internal Medicine Podcast

#77: Hypertension Guidelines Showdown

January 8, 2018
75 min

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

Tags:hypertension, blood, pressure, monitor, cuff, heart, aha, acc, act, stroke, cardiac, cardiovascular, event, guidelines, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

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