JACC This Week October 28.2025: How Low Should We Go? | JACC This Week
Oct 20, 2025
Dr. Harlan Krumholz dives into the hot topic of blood pressure targets, advocating for a goal near 120 mm Hg to boost cardiovascular health. He shares findings from the STEP and ESPRIT trials, showing that intensive control can reduce stroke risk and improve quality of life, even in older adults. The podcast highlights long-term benefits of early intervention and the importance of the new 2025 guidelines. Krumholz emphasizes the pressing need for consistent implementation of these effective strategies in clinical practice.
AI Snips
Chapters
Transcript
Episode notes
A Cadence For Deathbed Conversations
- Harlan Krumholz shares a teaching cadence for conversations when a patient dies to support families and trainees.
- He recommends honoring the person, reassuring about suffering, releasing guilt, and recognizing love in the room.
Use Risk Tools To Guide Treatment
- Use risk assessment tools like the 2025 AHA PREVENT equations to guide who should start pharmacologic therapy.
- Offer drugs up front for stage 1 hypertension when 10-year CVD risk ≥7.5% and emphasize lifestyle for others.
Retina Reveals Microvascular Repair
- ESPRIT fundus imaging showed wider retinal arterioles with intensive BP control, indicating microvascular repair.
- These small anatomic changes correlate with lower stroke, heart failure, and cognitive decline risks.