September 19, 2019
New Year New Hypertension Guidelines January 24 2018

New Year New Hypertension Guidelines January 24 2018


– Welcome to (muffled audio) event today. We’re going to be talking about
new hypertension guidelines. We had this conversation in December and decided we wanted to
continue it this month. There was a lot of interest
in the new guideline. Hey everyone. Welcome. I am Rebecca Wilson at HealthInsight and this is Katherine Luke. Thanks for joining us today for the Change Agents Learning and
Action Network webinar. We’re glad that you could join us today. It’s just now the bottom of the hour which is our official start time. So we’ll probably have some people join us but in respect out of all your time, we’ll go ahead and get
started with our agenda today. So first, this is the conversation today, New Year, New Hypertension Guidelines. We talked about this in December
if you were able to join us but there was so much
interest in it, the topic, and in the highlights
of a couple of clinics that we had on to talk about their home blood
pressure monitoring program that we wanted to talk
about it again today. And then we also really
want to hear from you. So keep that in the back of your mind; we want to know your questions. We want to know what you’re
doing with the new guidelines. We want to know if you’ve implemented any home blood pressure
monitoring programs. So we’ll get to that in a little bit. We’ve got Dr. Barry Stults from the University of Utah Medical Center to talk about guidelines and
then a little bit later on, in the second half of
the hour most likely, we’ll have Carrie and Jaime,
both from clinics in Utah, who have implemented successful home blood pressure monitoring programs. So everybody’s here and available to give you some information
and answer questions today. But before we get into the content, I just want to make sure
that you all are familiar with this platform. I don’t know how many of you have used this Zoom webinar platform before but if you hover along
the bottom of your screen, a toolbar should pop up
like the one that you see at the bottom here in black. And here you’ll find
some different functions. You’ve got participants
so you can see who else is on the call with us today
and you can raise your hand if you want to get our attention. There’s also a chat button. If you hit that, a window will open up and you can see on the bottom in blue, you can change whether you
want to send that message to everyone or to specific people but right now we would
encourage you to use the chat, you can see Edie in our New Mexico office has asked you to put in your name and the name of your practice you’re with. That’s always helpful for
us to know who’s calling in and where you’re all located. So take a minute and do that while I tell you about HealthInsight
if you’re not familiar. We’re the quality innovation network, quality improvement organization. We’re in four states: Oregon,
Nevada, Utah and New Mexico and I’m sure all of you are
calling in from those areas. And we really work on
the CMS quality strategy to eliminate disparities,
strengthen infrastructure and data systems, enable innovation and foster learning organizations much like this one here today. So thank you for joining us and
thank you for putting things in the chat. I see Nevada represented. I’m sure we have lots of others out there. I see your names on the screen. The things that helps our presenters too to know who they’re talking to. So first, we’re going to
take some time to go through the new hypertension
guidelines that were released in November. Dr. Barry Stults from the
University of Utah Medical Center and is a professor of clinical medicine, internal medicine and, really has specialized in the management of resistant hypertension. So thank you Dr. Stults. I will turn the time over to you and let you go through what’s new here. And if you put yourself
on mute or Rebecca, if you can unmute him. – [Dr. Stults] Hear me then. So the new guidelines from the American College of Cardiology and American Heart Association that came out in November
were commissioned by the National Heart Lung
and Blood Institute way back in 2014 and as we noted
last time in December, those guidelines were
reviewed and then accepted by the 11 different societies
that you see listed here but things have changed a little bit in that these same guidelines, at least the blood pressure
thresholds and targets were rejected by the American
Academy of Family Practice in mid-December and yesterday, by the American College of Physicians, which is one of the internal
medicine organizations. So we do have some controversy. As we’ve noted, these guidelines
are very comprehensive, covering: diagnosis, treatment, prevention and plan of care in 47 subsections, a very long document, 169 online pages that provide a 106 evidence-based
graded recommendations that are based on randomized
trials and meta-analyses of those randomized
trials but importantly, also on observational
studies and in some cases, on expert opinion. You can get this document
for free at the website that’s listed here on the slide. Next slide. So each one of these
guidelines is graded according to its strength as Class
I through Class IV, that is strong, moderate,
weak, no benefit or harm and each recommendation is
graded by its level of evidence, from Level A, more than one high quality
randomized trial supporting that evidence, all the
way down to Level C; expert opinion based
on clinical experience. Next slide. So, let’s talk about some
of the key recommendations, including a new blood
pressure classification scheme and the rationale for that. The recommendation that
out-of-office blood pressure is necessary to accurately
diagnose hypertension. New target blood pressure and threshold blood pressure levels. Hypertension therapy that
is guided not only according to the level of blood pressure
but now also according to the level of 10-year
cardiovascular risk. The fact that initial
low-dose, 2-drug therapy rather than one drug
therapy is favored for most although not all patients. That diuretics other
than hydrochlorothiazide are now recommended,
Indapamide and Chlorthalidone and the recommendation to adjust therapy using home blood pressure monitoring. Next slide. Let’s look
at each one of these. So this is the new classification scheme. As compared to JNC-7 in
2003, normal blood pressure is still defined as less than 120/80 but you can see the new ACC/AHA guidelines now define an elevated
pressure as 120-129/

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