{"id":8432,"date":"2025-08-24T09:45:12","date_gmt":"2025-08-24T06:45:12","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8432"},"modified":"2025-08-24T09:45:12","modified_gmt":"2025-08-24T06:45:12","slug":"new-blood-pressure-guidelines-key-takeaways","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/new-blood-pressure-guidelines-key-takeaways\/","title":{"rendered":"New Blood Pressure Guidelines: Key Takeaways"},"content":{"rendered":"
New Blood Pressure Guidelines: Key Takeaways<\/div>\n
<\/div>\n
Source: Medscape J.Mandrola, MD<\/div>\n
-August 21, 2025<\/div>\n
<\/div>\n
Four Things to Like<\/div>\n
1. Accurate BP Measurement<\/span><\/div>\n
\u2022 Guidelines place strong emphasis on proper technique: patient seated, feet on the floor, arm supported.<\/span><\/div>\n
\u2022 In practice, accurate measurement is almost never done correctly (the author notes in 30 years, he has never seen it done right).<\/span><\/div>\n
\u2022 A simple\u00a0improvement in this vital sign recording could instantly raise healthcare quality.<\/span><\/div>\n
2. Home-Based BP Monitoring<\/span><\/div>\n
\u2022 Class I, Level A: office BP readings should be supplemented with home monitoring.<\/span><\/div>\n
\u2022 Multiple RCTs show home monitoring + lifestyle changes \u2192 sustained BP reduction for \u226512 months.<\/span><\/div>\n
\u2022 Cuffless wearable devices remain unreliable for clinical use.<\/span><\/div>\n
\u2022 Patients need education: don\u2019t obsess over each reading; focus on averages over days to weeks.<\/span><\/div>\n
\u2022 Goal is not just \u201cgood BP,\u201d but also a \u201cgood life.\u201d<\/span><\/div>\n
3. Single-Pill Combination Drugs<\/span><\/div>\n
\u2022 Class I recommendation: fixed-dose combination pills for stage 2 hypertension (\u2265140\/90 mm Hg).<\/span><\/div>\n
\u2022 More effective, since most patients require >1 drug.<\/span><\/div>\n
\u2022 Improves efficiency: one pill, one prescription to fill\/refill \u2192 better adherence.<\/span><\/div>\n
4. Caution on Renal Denervation (RDN)<\/span><\/div>\n
\u2022 Evidence is weak: trials show either no significant benefit or only small reductions (3\u20135 mm Hg).<\/span><\/div>\n
\u2022 No sham-controlled efficacy data beyond a few months; no outcome data at all.<\/span><\/div>\n
\u2022 Guidelines give RDN a Class IIb rating (lowest recommendation), but inclusion in colored boxes risks premature widespread use.<\/span><\/div>\n
\u2022 Mandrola: RDN is not a long-term solution\u2014patients need BP control for decades, not months.<\/span><\/div>\n
\u2022 He believes RDN should not have been highlighted at all until stronger evidence exists.<\/span><\/div>\n
<\/div>\n
Two Concerns<\/div>\n
5. Summary Boxes & Simplified Statements<\/span><\/div>\n
\u2022 Guidelines start with \u201ctake-home messages\u201d and colored boxes.<\/span><\/div>\n
\u2022 Concern: This oversimplifies complex medicine and discourages clinicians from reading details and references.<\/span><\/div>\n
\u2022 Hypertension is one of the most important modifiable risk factors \u2192 requires deep knowledge, not shortcuts.<\/span><\/div>\n
\u2022 Summary boxes risk giving false confidence, while many patients don\u2019t fit neatly into algorithms.<\/span><\/div>\n
6. Use of the New PREVENT Risk Score<\/span><\/div>\n
\u2022 Treatment decisions are now based on both BP level + PREVENT 10-year cardiovascular risk.<\/span><\/div>\n
\u2022 Advantages:<\/span><\/div>\n
\u2022 Includes broader outcomes (HF, AF, stroke, CKD, atherosclerotic disease).<\/span><\/div>\n
\u2022 Based on more diverse, contemporary data.<\/span><\/div>\n
\u2022 Factors in kidney function and social determinants of health.<\/span><\/div>\n
\u2022 Provides better calibration of expected vs. observed risk.<\/span><\/div>\n
\u2022 Concerns:<\/span><\/div>\n
\u2022 PREVENT labels fewer patients as \u201chigh-risk\u201d \u2192 risk of undertreatment.<\/span><\/div>\n
\u2022 Removal of race from calculation may improve equity but could lower accuracy for vulnerable groups.<\/span><\/div>\n
\u2022 No trials directly comparing PREVENT with the older Pooled Cohort Equations (PCE) as risk modifiers.<\/span><\/div>\n
\u2022 Even a small degree of undertreatment in BP could be a public health disaster.<\/span><\/div>\n
<\/div>\n
Overall Message<\/div>\n
\u2022 Positive steps: focus on accurate BP measurement, home monitoring, and rational drug use (combination pills).<\/span><\/div>\n
\u2022 Major caution: avoid premature enthusiasm for RDN and beware of oversimplification (summary boxes, PREVENT risk).<\/span><\/div>\n
\u2022 Mandrola urges clinicians to read the full details of the 105-page guideline and understand the evidence deeply to prevent cardiovascular disease effectively.<\/span><\/div>\n
<\/div>\n
https:\/\/click.mail.medscape.com\/?qs=9932af753d52ee109d4b4a30a5f9590340bae40cb8e76bba78610ad82a948c05a41377285d62a512a291d485bbc55a23ca56897ee220641759c3bea8719421ef<\/a><\/div>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

New Blood Pressure Guidelines: Key Takeaways Source: Medscape J.Mandrola, MD -August 21, 2025 Four Things to Like 1. Accurate BP Measurement \u2022 Guidelines place strong emphasis on proper technique: patient seated, feet on the floor, arm supported. \u2022 In practice, accurate measurement is almost never done correctly (the author notes in 30 years, he has […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8432","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8432","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8432"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8432\/revisions"}],"predecessor-version":[{"id":8433,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8432\/revisions\/8433"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8432"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8432"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8432"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}