Good morning! This Wednesday I was asked to have an in-studio NPR radio interview with our favorite host. It was regarding the new blood pressure guidelinesand the sham stent study (say that 3x fast).
I arrived at the hospital early to review the guidelines and journal article. It was there I realized she had to reschedule to this upcoming Wednesday.
I had a couple hours before patients so I decided to interview myself.
Let’s call the host ‘Jan’. Here’s the transcript:
Jan: Good morning Dr. Sadgirl…Sumpter…Subgeer?
Thank you for joining us this morning. I see we are wearing the same bracelets? That’s fun. <pause>
She scans me up and down.
My goodness you are even funnier in person.
Me: But I haven’t said anything yet?
Jan: Erupts in laughter SEE! That’s exactly what I’m talking about. HAH!
Me: We’ve met before.
Me: Many of you are aware that 130/80 is the new 140/90. They’ve eliminated the category of pre-hypertension (120-139 systolic). They are now calling 120-130 “Elevated” and 130-139 is called Stage I Hypertension. 140 and above is now labeled Stage II Hypertension.
Jan: Why did they get rid of ‘pre-hypertension’?
Me: That’s a critical question Jan. They found people in that 120-130 mm Hg category have twice the heart attack and stroke risk of those under 120. They appropriately felt they were doing that group a disservice by not speaking to the importance of those numbers.
Jan: Wow. How many people now have high blood pressure?
Me: 103 million in the U.S. That is 46% of all adults.
Jan: Are these groups kowtowing to their sponsors to sell more blood pressure meds?
Me: You weren’t kidding. You are getting all right up in it.
Here are my thoughts (WWAD has no pharma sponsors). Probably not. There should not be a big step up in meds prescribed. The experts are strongly recommending that the 120-139 mm Hg group be addressed with 4 lifestyle changes (unless your ASCVD risk is >10% over the next 10 years). (1) Physical activity
(heeheehee), (2) Weight loss, (3) Salt reduction
, and (4) stress reduction
. Otherwise, no meds until above 140 mm Hg and that is similar to where we were sitting last week. We looooove the special focus on prevention.
Jan: David, why are you listening to Taylor Swift’s new album
during this interview?
Me: OMG, how do you know that?! Well truth be told…I’m testing it to see if I should recommend it to our millennial, Jessica.
Jan: Yeah right. I know Jessica, she’s twice the man you are.
The air quotes around man feel particularly hurtful.
She rotates and extends her arms
Can you really tell what my risk of heart attack and stroke risk is over the next 10 years?
Jan: One last question before we get to the landmark stent study. I’ve heard there’s a specific point of controversy. Do these blood pressure recommendations hold true for those over 60 years old? Haven’t they separated by ages in the past?
Me: They have separated in the past, not anymore. They’ve based these brand new guidelines on 900 studies that have accrued over last 14 years. They’ve found that the benefits still apply at all ages. Reading the physician blogs and posts since the release – there is definitely a subset of docs that are concerned about this positioning. Concerns of course surround going to low and causing broken hips. A systolic blood pressure in 100-110’s does not sentence anyone to broken bones. As always, it’s important to talk about your goals/risks with your family doctor.
Jan: Do the blood pressure cuffs at pharmacies work?
David: I thought you were only asking one more question? My ears are still hot from the Taylor Swift question. Yes, I strongly recommend my patients get a cuff to measure their BP at home. Multiple readings really help us establish which category you are in. It makes more sense to work from there. Would you be okay if we addressed the stent study next week Jan? We’re already at 720 words.
Jan: Honestly, David as a long time subscriber to the Walk newsletter, I’m absolutely shocked that you’re aware of a ‘word count’. And, yes, stents next week is a deal!