Asymptomatic HTN

[DocEspana]

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btw in february or march of this year ACEP changed the recommendations in a really subtle way. They previously used to say that you didn't need to start any new meds, just pass it off the PCP (and if you read the FULL report a lot of that is that since blood work isnt necessary on these patients but blood work IS needed to start any med except ccbs, just dont start meds so you dont have to draw blood). Now they say that we *should* start meds and/or increase current dosages if the reason is not noncompliance or just pain/anxiousness. They still make it very clear that there is no goal BP or any "dangerous" BP to act differently over. They are just making day zero of new treatment be the ED visit.

I have no problem with the recommendations.

I have a problem with them taking down (and completely wiping the internet of) their old recommendations which had SUCH a good patient-friendly summary of the "dont test, don't treat, don't worry' mantra. Now they only have the overly-dense medical version of the new guidelines.

 

[DocEspana]

You guys actually bother trying to educate other doctors on why it's pointless to send them in?

One of our PCP's sent in a woman who was ~200/100. No symptoms but apparently there were EKG changes. I looked at them and they were subtle STD or even non-existent. One of those kinds that you can barely see. I tried letting the PCP know there isn't much for us to do, and even said our national guidelines write to not treat and to let outpatient doctors treat. She was an outpatient doctor and sent her in anyway.

I don't even know if it's worth it these days.

I'm sure everyone else has said it, but you can't educate the PCPs. Not that its impossible but that 51% of those referrals are actually coming from their triage nurse, waiting room receptionist, or answering service, not the PCP. 44% are coming from physicians who "have been practicing this way for years and nothing bad has happened yet" and are closed to the idea of changing their patterns. About 5% actually sent them over for some other reason but the patient is too fixated on the BP to even know why they got sent.

 

[thegenius]

btw in february or march of this year ACEP changed the recommendations in a really subtle way. They previously used to say that you didn't need to start any new meds, just pass it off the PCP (and if you read the FULL report a lot of that is that since blood work isnt necessary on these patients but blood work IS needed to start any med except ccbs, just dont start meds so you dont have to draw blood). Now they say that we *should* start meds and/or increase current dosages if the reason is not noncompliance or just pain/anxiousness. They still make it very clear that there is no goal BP or any "dangerous" BP to act differently over. They are just making day zero of new treatment be the ED visit.

I have no problem with the recommendations.

I have a problem with them taking down (and completely wiping the internet of) their old recommendations which had SUCH a good patient-friendly summary of the "dont test, don't treat, don't worry' mantra. Now they only have the overly-dense medical version of the new guidelines.

You referring to this?

https://www.acep.org/siteassets/sites/acep/media/clinical-policies/final-cp-pdfs/asxhypertension-cp.pdf

 

[DocEspana]

You referring to this?

https://www.acep.org/siteassets/sites/acep/media/clinical-policies/final-cp-pdfs/asxhypertension-cp.pdf

Yup. The old page where they had a similar formal paper AND a simplified "two questions you need to know" based on the 2013 recommendations is gone. Which I understand based on them having new recommendations. But I really wish they left the old page because that "two questions you need to know" would need only the slightest modification to still be accurate and was so useful for reassuring patients that their asymptomatic htn is fine.