Jordy Cohen

ESC Guidelines for the management of elevated blood pressure and hypertension ESC Clinical Practice Guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure for the management of ele...

Agree with your comments

It mostly seems an extension/explanation of the ridiculous 2023 ESH guidelines (not to be confused with the superb 2024 ESC guidelines www.escardio.org/Guidelines/C...)

A whole section to renal denervation 🤔
And such strong language against BP < 120

Mind blown emoji

@jordybc.bsky.social this you?
Looks like an issue of JACC that needs to be read!

An article in print in the wild 🤯

(Thanks!)

The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association | Hypertension Over the past 3 decades, a substantial body of high-quality evidence has guided the diagnosis and management of elevated blood pressure (BP) in the outpatient setting. In contrast, there is a lack of ...

There you go:

www.ahajournals.org/doi/10.1161/...

@ahascience.bsky.social statement from HT heavyweights

The silent killer increases your risk of stroke and dementia. Here's how to control it New recommendations for early treatment of hypertension to prevent strokes, heart attacks and dementia come as an experimental medication is shown to lower blood pressure in hard-to-treat patients.

High blood pressure often shows no symptoms, but raises risk of stroke, heart disease, kidney damage, and dementia.
New American Heart Association guidelines: treat it early with diet & exercise.
“If you catch it early, you can gain many more years of healthy life,” says Penn’s Dr. Jordana Cohen.

And that’s a wrap!
In summary: screen carefully, stratify by risk, account for kidney health, and individualize therapy.
For nephrology, the wins are undeniable: albuminuria testing is mainstream, CKD visibility is heightened, and aldosterone is on the radar.

#NephJC

Tried to keep up on my phone while being held hostage in my toddler’s room 😳

Great chat!

#nephjc

T4l
1️⃣2️⃣No aggressive IV treatment for severe asymptomatic HTN - avoid acute inpatient lowering if no target-organ damage (COR III: Harm, LOE C-LD).
📝Treat the patient (situation) not the number for acute HTN during hospitalization. I have trouble convincing nocturnists of this. #NephJC

Preventing Microalbuminuria in Type 2 Diabetes | NEJM The multicenter double-blind, randomized Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) was designed to assess whether angiotensin-converting–enzyme inhibitors and non-dihydropyridine ...

www.nejm.org/doi/full/10....

There’s some trial data on prevention of albuminuria

#nephjc

a woman is holding a red megaphone in front of her mouth Alt: a woman is holding a red megaphone in front of her mouth

#nephjc

T4j
🔟CKD with albuminuria - ACEi/ARB strongly recommended to delay CKD progression and reduce CVD (COR I, LOE A).
📝Still only 35-50% of eligible patients get them. How do we move the needle on this? #NephJC

Cognitive impairment data

Yes! Slide care of Paul Whelton at this year’s #Hypertension25

#nephjc

T4i
9️⃣Cognitive protection🧠 - treat to SBP <130 to prevent mild cognitive impairment/dementia (COR I, LOE B-R).
📝Do you think BP control has a significant role in dementia? #NephJC

Table

Even when we say we will use MRAs earlier, we don’t! We showed this. Screening is associated with WAY more MRA use (probably in part because those who think to screen are more likely to treat based on best evidence)

pmc.ncbi.nlm.nih.gov/articles/PMC...

#nephjc

Proposed mechanism in Nature #NephJC
www.nature.com/articles/s41...

a black background with a gold circle and a la logo Alt: Pendulum

That was the goal with the encouragement without saying it’s absolutely required. It’s not feasible or appropriate in everyone/should be tailored to the individual.

Overall, it’s to swing the pendulum to aim lower when possible

#nephjc

PREVENT

Captures similar people

From the AHA scientific statement on PREVENT:

www.ahajournals.org/doi/10.1161/...

#nephjc

Undercover Aldosterone — NephJC This week, we will discuss the origins of primary hyperaldosteronism in normotensive patients. Could this undetected anomaly be the cause of idiopathic hypertension and CKD?

I would dare to say many people: if too young, if single pill combo is not enough to control BP. PA is more common than we are used to think. Usually, for us nephrologists is even harder to screen when pts are already on 4-5meds #nephjc

www.nephjc.com/news/primary...

PA recommendation

AHA/ACC came close! Anyone with BP >140/90

#nephjc

Annually #nephjc

#nephjc

PA recommendation

Same with the AHA/ACC guideline (well, close — anyone w/BP >140/90)!!
👇

The guidelines point out literature that home BP seems prognostically similar to ABPM and better for repeatability/longitudinal monitoring. We still use ABPM a lot, but for situations where we need more detailed data (BP lability, new target organ damage, unclear if home BPs are accurate)

#nephjc

This is what happens when there are 3 nephrologists on the writing committee 🤓

#nephjc

Calling out the shift to automated devices!

🩺Aneroid devices are easily miscalibrated and require frequent recalibration (plus perfect hearing!) — not the best option

🤖Automated devices aren’t prone to miscalibration but need to be correctly validated — check out www.validatebp.org

#nephjc

T0b
Is HTN still a problem worth our attention? Haven’t we conquered this ‘Silent Killer’ yet? Answers: YES it’s a problem, NO we’ve not conquered it.
#NephJC

T0c
Check out these sobering stats:
➡️More than 1.3 billion with HTN globally, 1.2 billion without control
➡️46.7 % HTN prevalence in the US from 2017 to 2020
➡️Leading cause of death and disability worldwide

#NephJC

a stuffed animal wearing a hockey helmet and a beard Alt: Gritty giving two peace signs

Jordy Cohen from University of Pennsylvania here for what’s certain to be an exciting #nephjc!

I’m perhaps biased as a member of the writing committee of the 2025 AHA/ACC BP guideline…

No other COIs

2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines | Hypertension AIM: The “2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults” retires and replaces the “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.” METHODS: A comprehensive literature search was conducted from December 2023 to June 2024 to identify clinical studies, reviews, and other evidence performed on human subjects that were published since February 2015 in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: The focus of this clinical practice guideline is to create a living, working document updating current knowledge in the field of high blood pressure aimed at all practicing primary care and specialty clinicians who manage patients with hypertension.

⏰2 hours until #NephJC chat
🔍 Tonight we are talking about the 2025 ACC/AHA Blood Pressure guidelines! Eight years have passed since the last update. What’s different? What’s the same? Tonight we tackle it all!