Conversation 4

Based on the Perspective article from NEJM

After reading the article, please discuss the accuracy of each of the statements below:

  1. Doctors should use self-monitored blood pressure values instead of office-measured blood pressure values for making decisions related to hypertension
  2. Can we say that even though the definition of hypertension has changed (based on the new ACC/AHA guidelines), not all people with a blood pressure value of more than 130/80 need pharmacological treatment.
  3. It is appropriate to initiate anti-hypertensive medication consisting of two anti-hypertensive drugs if the systolic BP is more than the 20mm Hg of the target value or the diastolic BP is more than 10mm Hg of the target.
  4. All patients - young or old - with hypertension should be treated to the same target value of less than 130/80mm Hg
  5. The change in terminology (what was called pre-hypertension earlier is now Stage 1 hypertension) is an effort to reduce "therapeutic inertia"
  6. According to the new ACC/AHA guidelines Stage 1 hypertension (BP between 130/80 and 140/90) should generally be treated with lifestyle changes only.
  7. It is possible that, because of the new guidelines, more people with a label of "hypertension" will be treated unnecessarily with medication.
  8. The results of the SPRINT trial (where a benefit was seen with treating hypertensives to a systolic target below 120mm Hg) should not be extrapolated to all hypertensives in the community
  9. Some people have high systolic pressures because of increased vessel wall stiffness and it is possible to recognise such people through their pulse pressures.
  10. The benefit of lowering systolic BP to below 130mm Hg in the elderly outweigh the risks of doing so.
  11. There are some groups of people with hypertension who can benefit from beta blockers as initial therapy even though the new guidelines do not recommend this group of medications for uncomplicated hypertension
  12. Treatment goals for hypertension should take into account the cardiovascular risk of such patients
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