In episode 462, James and Mike invite Scott Garrison to talk about some important nuances around guideline recommendations and how low we should lower systolic blood pressure. We look in detail at the SPRINT trial and then come up with a reasonable (in our minds) approach to what thresholds we should use.

Show notes 

BEDMED

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REFERENCES
U-Shaped Mortality Curves for Systolic BP

1) Clarify Registry

Vidal-Petiot E, Ford I, Greenlaw N, et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet. 2016;388(10056):2142-2152.

2) ONTARGET and TRANSCEND Trials

Bohm M, Schumacher H, Teo KK, et al. Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. Lancet. 2017;389(10085):2226-2237.

3) Chinese Longitudinal Healthy Longevity Study

Lv YB, Gao X, Yin ZX, et al. Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study. BMJ. 2018;361:k2158.

4) Blood Pressure Trajectories in the 20 Years Before Death

Delgado J, Bowman K, Ble A, et al. Blood Pressure Trajectories in the 20 Years Before Death. JAMA Intern Med. 2018;178(1):93-99.

5) MDRD Trial

Lazarus JM, Bourgoignie JJ, Buckalew VM, et al. Achievement and safety of a low blood pressure goal in chronic renal disease. The Modification of Diet in Renal Disease Study Group. Hypertension. 1997;29(2):641-650

7) ACCORD Trial

Group AS, Cushman WC, Evans GW, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575-1585.

7) SPRINT Main Findings

Group SR, Wright JT, Jr., Williamson JD, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103-2116.

8) SPRINT Ambulatory BP Sub-study

Drawz PE, Pajewski NM, Bates JT, et al. Effect of Intensive Versus Standard Clinic-Based Hypertension Management on Ambulatory Blood Pressure: Results From the SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory Blood Pressure Study. Hypertension. 2017;69(1):42-50.

9) Concern over SPRINT BP Measurement Technique

Agarwal R. Implications of Blood Pressure Measurement Technique for Implementation of Systolic Blood Pressure Intervention Trial (SPRINT). J Am Heart Assoc. 2017;6(2)

Kjeldsen SE, Mancia G. Unobserved automated office blood pressure measurement in the Systolic Blood Pressure Intervention Trial (SPRINT): systolic blood pressure treatment target remains below 140 mmHg. Eur Heart J Cardiovasc Pharmacother. 2016;2(2):79-80.

10) Comparison of Unobserved Automated Office BP and Ambulatory BP

Seidlerova J, Gelzinsky J, Materankova M, Ceral J, Konig P, Filipovsky J. In the aftermath of SPRINT: further comparison of unattended automated office blood pressure measurement and 24-hour blood pressure monitoring. Blood Press. 2018;27(5):256-261.

Kjeldsen SE, Mancia G. Unattended automated office vs. ambulatory blood pressure in people with high cardiovascular risk: implications for understanding the SPRINT results. J Hypertens. 2019;37(1):6-8.

11) Unattended and Attended SPRINT BP Readings Not Different

Johnson KC, Whelton PK, Cushman WC, et al. Blood Pressure Measurement in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2018;71(5):848-857.

12) Comparison Between SPRINT BP and Primary Care Office BP

Drawz PE, Agarwal A, Dwyer JP, et al. Concordance Between Blood Pressure in the Systolic Blood Pressure Intervention Trial and in Routine Clinical Practice. JAMA Intern Med. 2020.

In episode 461, James and Mike invite Tina Korownyk to talk about the important question of whether or not virtual visits are as good as face-to-face when it comes to diagnosing undifferentiated presentations.

Show notes 

Tools for Practice

Virtual visits versus face-to-face: Diagnostic accuracy in primary care

In episode 460, James and Mike invite Mike Kolber back again to answer the question does advising patients to abstain from alcohol reduce atrial fibrillation recurrence. The results may surprise you!

Show notes 

Tools for Practice

Be still my quivering heart: alcohol and atrial fibrillation

In episode 459, James and Mike invite Mike Kolber to talk about whether or not the increased rate of colorectal cancer in people under 50 means we should be screening earlier. We talk about all the numbers and put the risk into the context of the absolute numbers.

Show notes 

1) Tools for Practice

Is 45 really the new 50 in colorectal cancer screening?

2) Canadian task force on preventive health care – colorectal cancer 2016

In episode 458, James and Mike finally get back to being PREMIUM and cover a number of new and useful RCTs. We discuss 4 new Vitamin D trials, atrial fibrillation and do you need both rate and rhythm control, swollen legs and cellulitis, and is colchicine the new statin. Check out the PREMIUM podcast for all the answers.

Show notes 

1) Handout

2) Early Rhythm-Control Therapy in Patients with Atrial Fibrillation

August 29, 2020 DOI: 10.1056/NEJMoa2019422

In episode 457, James and Mike yet again invite Joey Ton to go through the evidence around reaching a target serum urate level in patients with gout. As with many arbitrary thresholds determined from observational studies (sometimes), or just made up, when you properly study if there is a benefit to achieving these levels the theory really crumbles under the weight of the evidence. We also briefly talk about the febuxostat vs allopurinol data and the outcomes that matter.

Show notes 

Tools for Practice

Who let the Gout Out? Targeting Uric Acid Levels in Treating Gout

In episode 456, James and Mike and Nic continue to go through all the evidence (primarily RCTs) around the use of masks and reducing the risk for viral illnesses. In this episode we talk about our systematic review and what we found for the public. Please also check out our simplified tool that describes all the information we found.

Show notes 

1) Masks for prevention of viral respiratory infections among health care workers and the public – PEER umbrella systematic review

Canadian Family Physician 2020;66:509-17

2) PEER simplified tool: mask use by the general public and by health care workers

3) Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

Lancet 2020 Jun 27;395:1973-1987

In episode 455, James and Mike invite Nic Dugré to go through all the evidence (primarily RCTs) around the use of masks and reducing the risk for viral illnesses for both healthcare workers and the public. In this episode we talk about our systematic review and what we found for healthcare workers – the following episode will be about the general public. Please also check out our simplified tool that describes all the information we found.

Show notes 

1) Masks for prevention of viral respiratory infections among health care workers and the public – PEER umbrella systematic review

Canadian Family Physician 2020;66:509-17

2) PEER simplified tool: mask use by the general public and by health care workers

In episode 454, James and Mike invite Adam Keough to go through all the evidence around the impact of long-term running. We find out that recreational running likely does not increase the risk of developing osteoarthritis but high-level elite athletes may have an increased risk. Interestingly, exercise is one of the most effective treatments for reducing osteoarthritic pain. So as with most things in life – it’s all a balance.

Show notes 

Tools for Practice

Exercise-induced osteoarthritis: Running into problems?

In episode 453, James and Mike invite Jessica Kirkwood to go over all the evidence for transitioning infants to solid foods using a baby-led weaning approach versus traditional spoon feeding. Overall, it really didn’t make much difference which approach was used. But listen to hear us take a bite out of all the nuances and context.

Show notes 

Tools for Practice

 “Does baby know best?”: Benefits and harms of baby-led weaning for transitioning to solid foods