The Curbsiders Internal Medicine Podcast #97 Hotcakes: Hypertension, Prostate Cancer Screening, Lifestyle & Mortality
May 28, 2018
A brisk journal-club romp through recent literature on blood pressure monitoring, treatment strategies, and the mortality links of ambulatory, white coat, and masked hypertension. Rapid-fire takes cover prostate cancer screening changes, intimate partner violence screening, alcohol and mortality, diabetes drug mortality data, DPP-4 inhibitors and IBD risk, teaching hospital mortality differences, biomarker-guided therapy, and lifestyle factors for longevity.
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Risk Based BP Strategy Is Promising But Not Ready
- Risk-based treatment may be more efficient than treating to a single BP threshold.
- A Weibull multivariable model treated fewer patients to prevent similar MACEs versus SBP targets, but was not clearly superior to a 140 mm Hg target and isn't ready for clinic use.
Always Repeat High Office Blood Pressures
- Repeat an elevated office BP measurement before making decisions because the second reading is often lower.
- JAMA Intern Med QI alert study (38k patients) showed mean systolic drop ≈8 mm Hg on repeat; only ~36% had repeat checks recorded.
Automated SPRINT Mode Cuff QI Trial Anecdote
- Matthew Watto described clinic workflow innovation using automated cuffs in SPRINT mode that take multiple readings and upload averages to the EHR.
- He plans a QI trial comparing an automated cuff arm to a rolling cuff colleague to see metric differences.