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The Role of Telemedicine
In Monitoring Blood Pressure
By Dustyn Williams, MD, Co-founder and lead educator at OnlineMedEd, Co-founder
at DoseDr, Clerkship Director Tulane Internal Medicine, LEAD
Hypertension, or high blood pressure, is a leading cause of
heart disease and stroke that has escalated to alarming rates
in recent years, affecting nearly 1 in 3 adults in the U.S. In
an attempt to reduce its prevalence, the Eighth Joint
National Committee (JNC-8) released a set of hypertension
management guidelines. However, various concerns arose
regarding the recommendations and as a result, the
American College of Cardiology (ACC) and the American
Heart Association (AHA), along with nine additional
specialty organizations, published an updated hypertension
guideline in November 2017.
The ACC/AHA updates were driven by the JNC-8
report’s narrow scope of recommended treatments, which
specifically focused on hypertensive patients without
comorbidities. Since hypertensive patients frequently suffer
from comorbid conditions, the guidelines led many to receive
inappropriate or inadequate medications. In addition to the
lack of focus on comorbid conditions, JNC-8 also dismissed
beta blockers, which are necessary for isolated hypertension
and embraced a “go-slow” treatment approach.
The newly released recommendations account for:
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Adjusting hypertension ranges and the initiation of
therapy
Setting ambulatory blood pressure monitoring as the
gold standard for diagnosis and management decisions
Prioritizing the treatment of comorbidities, such as
diabetes, in a timely manner
Using calcium channel blockers, diuretics, and ace-
inhibitors as first-line agents after comorbidities are
treated, or if none exist
Treating patients with multiple medications as
necessary if comorbidities do not exist
Major changes in guidelines
Lowering hypertension-related blood pressure ranges was a
significant adjustment in the ACC/AHA release, which will
subsequently increase the number of patients classified with
hypertension. Stage one hypertension systolic rates
originally ranged from 140-159 and diastolic rates from
90-99, and are now set at 130 systolic and 80 diastolic.
Stage two hypertension was altered from 160-179 systolic
and 100-109 diastolic to 140 systolic and 90 diastolic.
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