#77 Hypertension Guidelines Showdown

#77 Hypertension Guidelines Showdown

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, resid

Jaksot(500)

#473 Rapid Response Series: Narrow Complex Tachyarrhythmias with Dr. Noble Maleque

#473 Rapid Response Series: Narrow Complex Tachyarrhythmias with Dr. Noble Maleque

Don’t miss a beat as our guest Dr. Noble Maleque guides us through dominating narrow complex tachyarrhythmias (while keeping our own heart rates under control too). @Nobility75 (Emory University) Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Case 1, part 1: Unstable narrow tachyarrhythmias Case 1, part 2: Stable, narrow tachyarrhythmias – regular rhythm Vagal tone: Valsalva, Modified Valsalva, or Carotid Massage? Adenosine 2nd line AV nodal blockade: metoprolol, diltiazem Case 2: Stable, narrow tachyarrhythmias – irregular rhythm AV nodal blockade Amiodarone and diltiazem Rapid fire questions/Picks of the Week Outro Credits Please consolidate if performing multiple jobs (e.g. Written and Produced by: Cyrus Askin MD; cover art and infographic by Kate Grant) Producer, writer, Infographic, cover art, and show notes by: Caroline Coleman, MD Hosts: Meredith Trubitt, MD and Monee Amin, MD Reviewer: Rahul Ganatra, MD MPH Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Noble Maleque, MD Sponsor: Freed Start your free trial today, no credit card needed. Usecode: CURB50 to get $50 off your first month when you subscribe at Freed.ai  Sponsor: Grammarly Download Grammarly for FREE at grammarly.com/PODCAST Sponsor: Locumstory Visit free-to-use sponsor  at Locumstory.com

3 Maalis 1h 2min

#472 DIGEST: cfDNA & cancer in Pregnancy, Vitamin K2 for Leg Cramps, PRN anti-hypertensives, GLP-1 Agonists for AUD, Short-Course Antibiotics

#472 DIGEST: cfDNA & cancer in Pregnancy, Vitamin K2 for Leg Cramps, PRN anti-hypertensives, GLP-1 Agonists for AUD, Short-Course Antibiotics

Join us as we review recent articles and news featured in The DIGEST issues #59-61, including cfDNA and incidental detection of cancer in pregnancy, vitamin K2 for nocturnal leg cramps, the danger of as-needed anti-hypertensive medications in the hospital, GLP-1 agonists for alcohol use disorder, short-course (7 vs 14 days) antibiotics for bacteremia, and patient-collected HPV testing for cervical cancer screening. Fill your brain hole with a fully digestible meal! Featuring Laura Glick MD, Nora Taranto (@norataranto), Paul Williams (@paulnwilliamz), and Matt Watto (@doctorwatto).  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Introduction and Overview 02:57 The IDENTIFY study: Non-Invasive Prenatal Testing and Cancer Detection with cfDNA 05:54 Implications of Non-Reportable Results in Prenatal Testing 08:51 Vitamin K2: A New Approach to Managing Nocturnal Leg Cramps 12:07 Practicality and Future of Vitamin K2 in Clinical Practice 23:21 The Dangers of As-Needed Antihypertensives in the hospital 32:21 Exploring GLP-1 Agonists for Alcohol Use Disorder 40:24 Shorter Antibiotic Courses in Sepsis 46:09 Advancements in Patient-Collected HPV Screening for cervical cancer Credits Written and Produced by: Nora Taranto MD, Laura Glick MD, Matthew Watto MD, FACP; Paul Williams MD, FACP Show Notes: Nora Taranto MD Cover Art: Matthew Watto MD, FACP Hosts: Nora Taranto MD, Laura Glick MD, Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Emi Okamoto MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Disclosures The Curbsiders report no relevant financial disclosures.  Sponsor: Bombas Head over to Bombas.com/curb and use code curb for 20% off your first purchase. Sponsor: Pretty Litter  Go to PrettyLitter.com/curb to save twenty percent on your FIRST order and get a free cat toy.  Sponsor: Rocket Money  Cancel your unwanted subscriptions and reach your financial goals faster with Rocket Money. Go to RocketMoney.com/CURB today.

24 Helmi 54min

#471 Iron Deficiency Anemia with  Dr. Tom DeLoughery

#471 Iron Deficiency Anemia with Dr. Tom DeLoughery

Conquer the art of managing patients with iron deficiency anemia. We are joined by the amazing Dr. Tom DeLoughery, @Bloodman (Oregon Health & Science University). Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Rapid fire questions/Picks of the Week Case History and Physical Laboratory Findings Management of Iron Deficiency Anemia Diet Oral Supplementation Unexplained Iron Deficiency Case 2 IV Iron Supplementation IV iron reactions Case 3 Laboratory Follow Up Post Supplementation When to Refer to a Hematology/Oncology specialist? Outro Credits Producer,Writer, Show Notes, Cover Art, and Infographics: Sai S Achi  MD MBA FACP  Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Leah Witt, MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Dr. Tom DeLoughery MD, MACP, FAWM Sponsor: Mint Mobile Shop plans at mintmobile.com/curb. Sponsor: Freed Visit freed.ai and use code CURB50 to get $50 off your first month when you subscribe! Sponsor: Quince Give yourself the luxury you deserve with Quince! Go to Quince.com/curb for free shipping on your order and 365-day returns.

17 Helmi 1h 11min

#470 Thyroid Nodules and Thyroid Cancer for Primary Care

#470 Thyroid Nodules and Thyroid Cancer for Primary Care

Management and Ongoing Monitoring of Thyroid Neoplasms Join us as we dive deep into the approach for thyroid nodules with our two fantastic guests, Dr. Kaniksha Desai (Stanford Medicine) and Dr. Ana Chindris (Mayo Clinic)! Learn how to stratify these nodules for cancer risk and walk alongside our patients during treatment for thyroid cancer.  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro, guest bios Case From Kashlak Thyroid nodule evaluation and management Thyroid cancer diagnosis and treatment GLP-1s relationship to thyroid nodules and cancer Outro Credits Writer, producer, show notes, infographic, cover art: Alise Burke, MD  Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Emi Okamoto MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest:  Kaniksha Desai MD and Ana Chindris MD Sponsor: Panacea Let Panacea Legal help you today at Panacea.Legal Sponsor: Grammarly Download Grammarly for FREE at grammarly.com/PODCAST Sponsor: Babbel Babbel is gifting our listeners 60% off subscriptions at Babbel.com/CURB.

10 Helmi 1h 23min

#469 Inpatient Heart Failure

#469 Inpatient Heart Failure

Diuresing ‘til the heart's content Master inpatient heart failure management! Learn key tips for initiating guideline-directed medical therapy, diuretic therapy pearls, and ensuring smooth transitions of care. We are joined by Dr. Gurusher Panjrath @PanjrathG (GW School of Medicine and Health Sciences-Dr. Panjrath) Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Rapid Fire Questions/Picks of the Week Case Aliquot 1 Defining Heart Failure POCUS in Heart Failure Timing/Indications for Echocardiography Initiating Diuretic Therapy Adjusting Diuretic Therapy/Drip vs Bolus Adjunct Diuretic Therapy Afterload Reduction Monitoring Diuretic Response Inpatient Sodium and Fluid Restriction Case Aliquot 2 Classifying Heart Failure Pharmacotherapy for HFrEF Pharmacotherapy for HFpEF Ischemic Evaluation Interval Summary/Highlights Case Aliquot 3 Considerations for Initial Care of Cardiogenic Shock Choosing Inotrope/Vasopressor Right Heart Catheterization Case Aliquot 4 Discharge Medications for Heart Failure Titration of Goal Directed Medical Therapy Post Discharge Follow Up Washout Period for ACEi/ARB Cost/Barriers of ARNI Patient Education Take Home Points Outro Credits Writer, Producer, and Show Notes by: Reaford Blackburn, Jr., MD Infographic & Cover Art: Caroline Coleman MD Hosts: Monee Amin, MD and Meredith Trubitt, MD    Reviewer: Rahul Ganatra MD Technical Production: PodPaste Guest: Gurusher Panjrath, MD Sponsor: CME Meeting  Visit www.CMEmeeting.org/curbsiders to explore all offerings and claim your discount. Whether live, online, or on-demand, Continuing Education Company makes earning CME easy and rewarding. Special offer for Curbsiders listeners: Save 30% on all online courses and live webcasts with promocode CURB30 Sponsor: Rocket Money Cancel your unwanted subscriptions and reach your financial goals faster with Rocket Money. Go to RocketMoney.com/CURB today. Sponsor: Freed Visit get freed.ai and Usecode: CURB50 to get $50 off your first month when you subscribe!

3 Helmi 1h 30min

#468: Asthma Update with Cyrus Askin

#468: Asthma Update with Cyrus Askin

2024 GINA Strategy, peak expiratory flow insights, SMART therapy, and other asthma pearls that will leave you breathless Master the art of diagnosing and managing asthma with practical, evidence-based strategies. Learn how to approach the initial interview, gain comfort with key diagnostic tools like spirometry and PEF, and optimize therapy using the latest GINA report. We’re joined by Dr. Cyrus Askin, a longtime Curbsiders member returning as our guest expert to share his insights as a pulmonologist.  X profile (formerly twitter):  @Askins_Razor  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Case Topic Rapid fire questions/Picks of the Week Outro Credits Written and produced by Paul Wurtz MD. Show notes, cover art, and infographic also created by Paul Wurtz MD. Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Sai S Achi MD, MBA, FACP Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Cyrus Askin MD Sponsor: Babble Babbel is gifting our listeners 60% off subscriptions at Babbel.com/CURB.  Sponsor: Bombas Head over to Bombas.com/curb and use code curb for 20% off your first purchase.  Sponsor: Pretty Litter  Go to PrettyLitter.com/curb to save twenty percent on your FIRST order and get a free cat toy.

27 Tammi 1h 25min

#467 Unintentional Weight Loss with Dr. Eva Szymanski

#467 Unintentional Weight Loss with Dr. Eva Szymanski

Become a mini geriatrician in our new Geriatrics series! Geriatricize your knowledge of caring for older adults with unintentional weight loss! You’ll round out your history taking and weight gain plan by harnessing the age-friendly “5Ms”. We’re joined by Dr. Eva Szymanski (@eva_szy), expert geriatrician at Penn Medicine. Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Rapid fire questions Case Defining Unintentional Weight Loss Applying the Geriatric 5Ms Framework Diagnostic Work-Up Addressing Ageism in Medical Decisions Defining Geriatric Syndromes Weight Loss Treatments Outro Credits Producer: Leah Witt, MD, Rachel Miller, MD, MSEd Writers: Abigail Schmucker, MD, Joseph Young, MD, Margaret Heller, MD, Alyson Michener, MD, Leah Witt, MD Show Notes, Infographic and Cover Art: Leah Witt, MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Molly Heublein, MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Eva Szymanski, MD Sponsor: Quince Upgrade your closet this year without the upgraded price tag. Go to Quince.com/curb for 365-day returns, plus free shipping on your order! Sponsor: Freed Visit Freed.ai and use code CURB50 to get $50 off your first month.  Sponsor: Mint Mobile Switch to Mint and new customers can get half off an Unlimited plan until February 2. To get your new wireless plan for just $15 a month, and get the plan shipped to your door for FREE, go to MINTMOBILE.com/curb

20 Tammi 1h 8min

#466 Cirrhosis Update with Scott Matherly

#466 Cirrhosis Update with Scott Matherly

Update your approach to cirrhosis evaluation and management with Dr. Scott Matherly Associate Professor of Hepatology and Gastroenterology at Virginia Commonwealth University  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro, disclaimer, guest bio Case from Kashlak; Definitions Cirrhosis Diagnosis and Initial Evaluation  Cirrhosis Physical Examination  Decompensated Cirrhosis Management  Ascites and TIPS MELD and transplant consideration Outro Credits Written and Produced by: Elena Gibson MD Infographic and Cover Art: Edison Jyang MD Hosts: Paul Williams MD, FACP; Elena Gibson MD     Reviewer: Emi Okamoto MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Scott Matherly MD  Sponsor: Rocket Money Cancel your unwanted subscriptions and reach your financial goals faster with Rocket Money. Go to RocketMoney.com/CURB today.  Sponsor: Rosetta Stone Visit rosettastone.com/curbsiders for 50% off unlimited access to 25 language courses for the rest of your life.  Sponsor: Grammarly  Download Grammarly for FREE at grammarly.com/PODCAST.

13 Tammi 1h 21min

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