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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Pim Fortuyn

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