#NephMadness 2019: Hustle and Heart Set US Hypertension Guidelines Apart

Posted on April 4, 2019 by AJKDblog in NephMadness // 0 Comments

Dia Waguespack @d_r_waguespack

Dia Waguespack is an Assistant Professor of Medicine and Associate Program Director of the Nephrology Fellowship at McGovern Medical School at UTHealth in Houston, Texas. She is an avid educator and serves as an Associate Director of #GlomCon Conferences. Her clinical research interests include glomerulonephritis and CKD.

Competitors for the Hypertension Region

EU Guidelines vs US Guidelines

Hyperaldo Diagnosis vs Hyperaldo Treatment

As the US Guideline on hypertension is largely based on cardiology standards with little input from nephrologists, now more than ever it is time for the Team US Guidelines to make their mark at the Big Dance.

Hypertension is a global health problem with significant morbidity and mortality if left untreated. Financial implications from complications of the disease, as well as medication costs, are a significant burden on health care systems.

Not only must we have clear measurement goals to guide therapy but we must also understand accurate techniques used to measure blood pressure (BP). Clinicians’ knowledge of the techniques used to obtain BP assessments in clinical trials, which guide our recommendations, is important. More important is knowledge of how measurements are obtained in our daily clinical practices. Accurate measurements are the first step in achieving set guidelines, as without a proper reading therapy cannot be applied or adjusted with any precision. You can’t take the court for tip-off if all five players can’t dribble, pass, and shoot. This is of key importance for our individual daily practice. Review of the game footage likely will reveal opportunity for standardization and quality improvement in outpatient BP measurement. The end goal of improved diagnosis and management will allow us to obtain data closer to the standard measurements taken in published studies such as SPRINT.

The US Guideline also provides some clarity, or at least tip the conversation, on which measurements we should be using. The guideline discusses the use of home BP measurements for confirmation and therapy adjustments (Check out the NephMadness scouting report section on home BP measurements). Home BP readings expand our playbook and can provide a more comprehensive approach to treatment.

When developing a game plan you must first know and understand the talent on your team. The same is true for application of study results to our individual patients. The US Guideline offers an approach to best treat a majority of patients supported by the most recent and ‘best’ available evidence. As a coach, a game plan is only successful if your players can execute it. The US Guideline, with a goal of <130/80 mm Hg, keeps it simple and provides the most likely benefit to the greatest amount of patients. The complexity of the EU guidelines, particularly for a vast disease that will be treated by a variety of physicians trained in different specialties, could lead to possible confusion and lack of precision in execution. Thus, simplicity with knowledge of applicability is a solid approach.

Hypertension will continue to be a contender for years to come. But the quality of our published studies is on the rise… “US Guideline down by 2 with 1.9 seconds left, inbounding with a pass and quick release at mid-court, draining the shot at the buzzer for the NephMadness win!”

– Guest Post written by Dia Waguespack @d_r_waguespack

As with all content on the AJKD Blog, the opinions expressed are those of the author of each post, and are not necessarily shared or endorsed by the AJKD Blog, AJKD, the National Kidney Foundation, Elsevier, or any other entity unless explicitly stated.