Treatment thresholds and timing for medication

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.

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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.
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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  

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