WIHI: How High? How Low? Shared Decision Making Amidst Shifting (Hypertension) Guidelines

Produced in collaboration with the Journal of the American Medical Association (JAMA)

Date: March 13, 2014

Featuring:

  • Craig W. Robbins, MD, MPH, Medical Director, Center for Clinical Information Services, Kaiser Permanente Care Management Institute
  • Don Goldmann, MD, Chief Medical and Scientific Officer, Institute for Healthcare Improvement
  • Peter Basch, MD, FACP, Medical Director, Ambulatory EHR and Health IT Policy, Medstar Health
  • Eric Peterson, MD, MPH, Director, Duke Clinical Research Institute; Professor of Medicine, Division of Cardiology, Duke University Medical Center
 
Hypertension is a hot issue, especially in the US, where an expert committee recently recommended that the available evidence does not support initiating treatment (largely medication) for people 60 years or older until their blood pressure climbs to 150 over 90. The decades-long consensus had been to initiate treatment at 140 over 90, which is still the recommendation for adults younger than 60. The reasons for this change are possibly as complicated as the guideline process itself, but one of the chief concerns of the majority on the Eighth Joint National Committee (“JNC 8”) is the risk associated with aggressive treatment of hypertension in older adults.
 
So, can we talk about this? We invite you to listen to this special WIHI produced in collaboration with the Journal of the American Medical Association. The discussion was constructive and forward-looking.
 
Some experts take exception to the committee’s findings and the process itself. Our guests are going to take all that into consideration, but, with your help, we’ll focus primarily on the best ways to approach changing and often-debated guidelines when working with patients to achieve optimal health. (The new guidelines for determining who should be put on statins to lower cholesterol are another case in point.)
 

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