Individualizing Blood Pressure Goals in Older Adults: A Podcast with Mitra Jamshidian, Simon Ascher and Mark Supiano
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
46 min
2 speakers
8 chapters
transcribed 10 hours ago
Transcript
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What is the ideal blood pressure target for older adults with hypertension?
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Welcome to the JerryPal Podcast, is Eric Widera. This is Alex Smith. And Alex, today we're going to be talking about individualizing blood pressure in older adults. Who do we have on the show with us?
We are delighted to welcome Mitra Gemshitian, who is a nephrologist and researcher at UCSF and San Francisco General Hospital. Mitra, welcome to the JerryPound Podcast.
Hi. Thanks for inviting me.
We're delighted to welcome Simon Asher, who's a hospitalist researcher at UC Davis. Simon, welcome to the JerryPow podcast.
Thanks for having me.
And we're delighted to welcome back Mark Suppiano, who's a geriatrician researcher at the University of Utah. I looked it up, Mark. We we had did we has it been this long? Did we last have you on in 2017? Holy smokes. How low
should we go with blood pressure? Wow. Delighted to be back. Yes. That was right after the sprint study results were published, as I recall.
It's so great to have you back and it's been too long. Well so glad to have you with us, Mark.
Happy to be here. Thanks for the invitation.
So we got a lot to talk about. We're gonna take a deep dive in blood pressure and older adults, but before we do, Simon, do you have the song request for Alex?
Yeah, yeah, I was thinking about uh Frank Sinatra's My Way. Why are you choosing Frank Sinatra My Way? I mean first I'm just excited to hear Alex play it, but uh I don't think he's ever done a
Frank Sinatra song before. This is a first. He's a crooner at heart. So we'll see
fifty songs
and this is a first. All right. Well now I'm especially looking forward to it. But uh yeah, I also think that uh Sinatra reflecting on how he lived his life his way, making its own choices, fits uh with this topic of personalized blood pressure goals and allowing patients to express what matters most to them.
Right. Great. Here's a little bit. I'll do the um the intro here and then at the end I might go for it, bite off more than I can chew. We'll see. And
no The end is here. And so I face Final curtain. My friend. I'll say it clear. I'll stake my case. Of which I'm certain. I've lived Of the life that's born I travel easy. And every highway. And more much more than this, I did it.
That was great,
Alex.
Thank you, Simon. I worked on for a long time. Thank you so much. Thank you.
Oh, thank you. Now I uh can avoid my blood pressure medicine. That really brought me down ten points.
So I was actually just listening to an AGS talk by Jeff Williamson, and uh, you know, the thing that struck me was he was talking about when he was in training how they defined blood pressure. It was, I believe it was like ninety or a hundred plus your age. I I actually forget the first number, but it was like if you were 70 years old, your aver the normal blood pressure was like 170. I wonder it sounds like we've progressed since those times. How are we defining high blood pressure nowadays? I'm gonna take a big, big step back before we talk about individualizing blood pressure. Let's talk about what is hypertension.
How have hypertension guidelines changed since the 2017 discussion on SPRINT?
I mean, I think every organization defines it differently. So like the WH Show defines it as one forty over ninety, but as a nephrologist, I follow KDGO guidelines, which say that a patient who has TKD who's not on dialysis has bite high blood pressure if their blood pressure is above one twenty.
One twenty. They have hypertension at one twenty. Any other thoughts?
So a lot lots. So back in 2017, when I joined you to talk about the sprint results, the American Heart Associate guidelines had just been published, which lowered the threshold previously had been 140 down to 130. So the AHA current guideline is at 130. My understanding is that guideline is being revised this year, and uh we expect to see a new guideline published sometime later this year. So it has been a moving target, but it is based on evidence, and some of the evidence we'll dive into today.
Well, uh was that the guideline where there was like pre hypertension, which was like one twenty to one twenty nine?
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Chapters
8 chapters
1
What is the ideal blood pressure target for older adults with hypertension?
0:00–4:00
2
How have hypertension guidelines changed since the 2017 discussion on SPRINT?
4:00–9:06
3
What were the main findings of the SPRINT trial for intensive BP control?
9:06–14:39
4
How do benefits and harms of intensive BP lowering differ in frail versus fit older adults?
14:39–22:03
5
What does the new JAGS framework reveal about net benefit of intensive BP control?
22:03–27:43
6
How can clinicians individualize BP goals using patient preferences and risk profiles?
27:43–33:05
7
What are the challenges and gaps in applying intensive BP targets to nursing‑home residents?
33:05–38:11
8
Should we adopt a universal <120 mmHg target or continue to personalize BP goals for older adults?
38:11–46:39
Speakers
2 identifiedMore from GeriPal - A Geriatrics and Palliative Medicine Podcast
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