#97 Hotcakes: Hypertension, Prostate Cancer Screening, Lifestyle & Mortality

May 28, 2018 | By Sarah Phoebe Roberts

Keep current with this monthly journal club covering landmark articles through May 2018, plus rapid fire hot takes from the medical literature and health news. We rate each article according to a highly scientific ‘Hotcakes’ scale to highlight what practice-changing knowledge we’ll take to work this month. Topics: Hypertension, blood pressure monitoring, prostate cancer screening, Intimate Partner Violence screening, alcohol is killing you, new diabetes drugs and mortality, DPP-4 inhibitors and IBD risk, NT-proBNP-guided therapy vs usual care, effect of teaching status on mortality, and more! If you’re a listener and have something interesting for us to discuss, please send it our way.

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Credits

• Written and produced by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH
• Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD
• Editor: Matthew Watto MD

Part 1: Hotcakes! Main article reviews

Stuart: Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure. PLoS 2018 PMID: 29558462

• Major takeaway: Framingham Risk Calculator sensitivity analysis: “The results, while qualitatively similar, had a lower area under the curve, suggesting worse performance of the CVD risk strategy using an externally derived prediction algorithm.” -Dr Brigham

Paul: Association of Repeated Measurements With Blood Pressure Control in Primary Care. Einstadter D et al. JAMA IM 2018

• Major takeaway: Repeat the blood pressure at each office visit. Values are likely to be significantly lower on subsequent readings and not just because of “regression to the mean”. -Dr Williams

• See also: Thomas Schwenk’s article on multiple blood pressure readings for HTN follow-up

Matt: Relationship between Clinic and Ambulatory Blood-Pressure Measurements & Mortality. Banegas JR et al. NEJM 2018.

• Major takeaway: Look out for masked HTN, which confers the highest mortality. White coat HTN has a significant mortality risk that goes away with antihypertensive therapy. All phenotypes of HTN show a mortality benefit with BP treatment. -Dr Watto

• See also: Allan Brett’s article on ambulatory blood pressure monitoring and Bruce Soloway’s article on home vs. clinic blood pressure monitoring. Masked hypertension review by William S Aronow

Part 2: Hot Takes

“Hot Takes” are bite-sized summaries of recent articles and news headlines we thought our listeners might find interesting.

Guideline updates:

• USPSTF updates guidelines on prostate cancer screening. JAMA. 2018;319(18):1901-1913.  
  • Vinay Prassad’s recent “tweetorial” about PSA screening
   
  • JAMA Clinical Reviews Podcast

• USPSTF draft recommendations on Intimate Partner violence Screening  
  • The HARK IPV screening tool

In the Lay News Media:

• Alcohol is slowly killing you (CNN.com April 13, 2018).
• This Lancet study by Wood AM et al from April 2018 agrees
• Cognitive decline may occur with moderate alcohol consumption (Topiwala A et al. BMJ 2017;357:j2353)

DPP-4 research:

• In DM2, SGLT-2 inhibitors or GLP-1 agonists reduce mortality more than placebo, no treatment, or DPP-4 inhibitors (Zheng SL et al. JAMA. 2018;319(15):1580–1591)

• DPP-4 inhibitor use may be associated with increased risk of IBD (Abrahami D et al. BMJ 2018. See also: This article in ACP Gastroenterology monthly

BNP: 

• In acute decompensated HF, NT-proBNP-guided therapy vs usual care did not differ for death or HF readmission or days alive out of hospital at 6 months (Stienen S et al. Circulation. 2018;137:1671-1683).  

• 2017 Focused update to AHA g/l on heart failure recommends BNP as prognostic tool (Yancy CW et al. Circulation. 2017;CIR.0000000000000509)

• BNP Predicts mortality from York MK et al. JACC. May 2018.

• Amy Orciari Herman’s Journal Watch article

Life in Medicine

• Association Between Teaching Status and Mortality in US Hospitals (Burke LG et al. JAMA. 2017;317(20):2105-2113.)

• 5 Lifestyle Factors Could Add More Than 10 Years to Life Expectancy (Li Y et al. Circulation. 2018)  
  1. Healthy Diet  
  2. Never Smoking  
  3. Moderate-to-vigorous physical activity (at least 30 min/day)
  4. Moderate alcohol consumption “We defined low-risk alcohol consumption as moderate alcohol consumption, for example, 5 to 15 g/d for women and 5 to 30 g/d for men.” -Y Li et al. Circulation. 2018  
  5. Healthy BMI

Part 3: Chiu’s Bites

A few more articles/new items that we recommend checking out!

• Systematic review on Cefepime neurotoxicity from Open Forum Infectious Disease (was highlighted in Paul Sax’s blog)

• Liberal vs Conservative Oxygen Therapy (IOTA review) – results support the conservative administration of oxygen therapy was beneficial in acutely ill adults.

• 6 month update from ADRENAL study – In adult patients with septic shock, hydrocortisone did not affect mortality at 6 months, which is in keeping with previous publications.  
  • Great blog post from Patricia Kritek, MD about the ADRENAL, APROCCHSS, and SMART trials.  

• 10 Things the ICU specialist needs to know about DOACs (and any internist) from Intensive Care Medicine  
  • Related: ‘Ten Commandments’ of the EHRA Guide for the Use of NOACs in AF from the European Heart Journal –

• NSAIDS:  
  • In patients with rheumatoid arthritis, non-selective but not selective NSAIDs were linked to increased risk for stroke or AMI.
   
  • NPR reports “FDA Panel Affirms Safety Of Painkiller Celebrex”  
    • NEJM Journal Watch Commentary on 2016 PRECISION trial
     
    • April 2018 PRECISION secondary analysis about Celebrex + ASA vs NSAIDS + ASA –

• Highlighted by Stuart on this episode, but cut from final edit. Sorry, Stu!:  
  • Association of the Hospital Readmissions Reduction Program Implementation With Readmission and Mortality Outcomes in Heart Failure

• History and Physical Exam Pearls (thanks to Tony Breu & Avital O’Glasser on Twitter!)  
  • Toenails as the “Hemoglobin A1c” of Functional Independence—Beyond the Polished Wingtips 
   
  • Clinical Decision-Making: Observing the Smartphone User An Observational Study in Predicting Acute Surgical Patients’ Suitability for Discharge

• In the Lay News:  
  • From the New York Times: Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis
   
  • Also from the New York Times: Injecting Drugs Can Ruin a Heart. How Many Second Chances Should a User Get?

• Life in Medicine  
  • Physician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause? –
   
  • Ego is the Enemy (in FOAMed) via Life In The Fast Lane
   
  • Bedside Rounds Podcast from Adam Rodman

Goal:  Listeners will keep current on the medical literature, health related news stories, and learn critical appraisal.

Learning objectives:
After listening to this episode listeners will…

Learn about the most important journal articles from the month and their salient points

Learn a practical approach to critical appraisal

Learn what medical news is being widely reported in the lay media and the underlying evidence in the literature

Disclosures: The Curbsiders report no relevant financial disclosures.

Time Stamps

• 00:00 The Curbsiders need a webmaster

• 00:50 Disclaimer

• 01:25 Intro to the format

• 03:25 Ambulatory BP monitoring and mortality

• 09:08 Blood pressure treatment strategies: CVD risk score vs systolic BP targets

• 14:14 Repeated BP measurements important at office visits and future directions of BP management

• 21:25 Hot takes in order of appearance: Prostate cancer screening, intimate partner violence, alcohol, DPP4 inhibitors mortality and IBD, teaching status and mortality in US hospitals, 5 lifestyle factors that may add to life expectancy, NT pro-BNP, BNP and mortality

• 38:12 Outro

Links from the show: See above. Links are embedded in each section.