CEimpact Podcast

Advancing Hypertension Care to Improve Patient Outcomes

Share episode

Hypertension remains a leading contributor to cardiovascular disease, but advancements in its management are reshaping treatment strategies. This episode highlights the latest updates in hypertension guidelines, emerging therapies, and practical approaches pharmacists can use to optimize care. Don’t miss this chance to stay informed and elevate your role in improving patient outcomes.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Joseph Saseen, PharmD, BCPS, BCACP, CLS, ASH-CHC
Professor and Associate Dean for Clinical Affairs
University of Colorado
 
Pharmacist Members, REDEEM YOUR CPE HERE!
 
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)


CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe recent updates in hypertension management guidelines and their implications for patient care.
2. Identify emerging therapies and evidence-based strategies pharmacists can use to optimize hypertension treatment and improve outcomes.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-058-H01-P
Initial release date: 3/10/2025
Expiration date: 3/10/2026
Additional CPE details can be found here.

Follow CEimpact on Social Media:
LinkedIn
Instagram

Speaker 1:

Hey, ce Impact subscribers, Welcome to the Game Changers Clinical Conversations podcast. I'm your host, josh Kinsey, and as always, I'm super excited about our conversation today. Hypertension continues to be a silent yet powerful driver of cardiovascular disease, affecting millions worldwide. In this episode, we'll dive into the latest updates in hypertension care, uncover new therapeutic options and discuss how pharmacists can lead the way in optimizing treatment and improving patient outcomes. It's so great to have Joe Sassine as our guest expert for today's episode. Welcome, joe, thanks for joining us.

Speaker 2:

Well, thank you for having me.

Speaker 1:

Yeah, we appreciate you taking time out of your busy schedule. So before we jump in for our learners who may not know you, Joe, if you'll just take just a few minutes to kind of introduce yourself, Tell us a little bit about your current role and practice site and maybe why you are passionate about hypertension.

Speaker 2:

Sure, my name is Joe Sassine. I'm from the University of Colorado. My current role is I'm a professor, so I'm an academician that teaches practices in primary care, specifically a family medicine clinic, and I also do some clinical research. I also have some administrative duties as associate team for clinical affairs, where I oversee the clinical relationships that we have with our faculty at the University of Colorado and our clinical partners at the hospital. That's the University of Colorado Hospital and CU Medicine a whole bunch of different entities there.

Speaker 2:

But, I've been in the hypertension space ever since I finished my postgraduate PharmD degree. So I became a pharmacist back when it was a BS degree and I really enjoyed chronic diseases and having an impact on patients' healthcare long-term and so that sort of led me to this field in ambulatory care when it was very unpopular there was no pharmacists that actually were really practicing that area but I was interested in it, got my PharmD degree and then I did a research fellowship in basically cardiovascular outpatient treatment, mostly hypertension and dyslipidemia. So I've been in this space ever since then. What I do now, what we do in my clinical role, which is now a smaller part of my job but still an important part of my job I'm part of a clinical team. We work in primary care. We work under collaborative practice agreements where we manage chronic diseases, one of which is hypertension, and along with a whole bunch of other cardiometabolic diseases that are important to patients.

Speaker 1:

Yeah, that's great. Well, thanks again for taking time out of what appears to be a very busy schedule, so I appreciate it so much. I loved your explanation. You have a few administrative roles. I also have previously been in academia and I know that a few translates into probably hundreds. So so, yeah, thanks, thanks again.

Speaker 1:

So let's jump right in. We've got a big topic, obviously probably one of the most, I guess, prevalent diseases that we see in our patients, one of the most common things that we're going to see in our patients, and probably something that is most common to pharmacists. Like, we all know what hypertension is. We all know kind of you know what the issues are, but it's just it's such an important topic so we really wanted to dig further into it. It's been a while since we've kind of approached the subject with a course here, so we really wanted to dig further into it. It's been a while since we've kind of approached the subject with a course here, so we really wanted to kind of get into it. So, tell us a little bit, just set the stage, make sure we're all on the same page. Let's talk just a little bit about hypertension. You know what its prevalence, its impact on public health and the role of the pharmacist in the management. So just a brief introduction to it.

Speaker 2:

Sure you, knowension is something that our patients are in tune to, because every medical visit they get their blood pressure measured.

Speaker 2:

So it tells you right there that looking at elevated blood pressure is important. And it's important because cardiovascular disease is the number one cause of mortality in the United States. It has been for over a century and a major independent risk factor is hypertension, or elevated blood pressure. Using our newer definitions, which aren't so new anymore, 2017 was somewhat of a game changer, where the blood pressure goal dropped, according to our United States American College cardiology guidelines, down to less than 130 over 80 is sort of that goal have most patients at, and when you use 130 over 80 as a cut point, almost 50% of adults have hypertension. Wow, and that's gone up from the previous definition. Some clinicians still use a higher blood pressure goal.

Speaker 2:

I have strong opinions on whether you should do that or not. You have to be have a really good reason to do that, because most patients should be treated less than 130 over 80. That made the prevalence go from more than a third to almost half in the adult population, so it is something that's an old disease with a lot of treatments that are not really that that expensive, so it's something that should be in our, you know, drug therapy armamentarium. We've got a ton of tools in that treasure chest of viable options. We just continue to have patients with what we call clinical inertia. They have the disease, they have a diagnosis, they're on treatment, but it simply is not enough.

Speaker 1:

Wow, yeah, and I was just thinking. I've had some bouts previously. I think mine are based on I do not like having my blood pressure taken and so as soon as you put the cuff on my arm it spikes. So I think that's typically why I have bad readings when I go into the clinic or whatever. But you know just in general, like how many people over half you say, but how many people don't even know or haven't even been diagnosed with it.

Speaker 2:

So that is, that is what is mind boggling, because yeah, yeah, you're right, because that half is really true hypertension. Some of those people, they're not controlled because they simply are unaware unawareness. I mean it's, you know, sometimes it's unawareness because we want to be unaware.

Speaker 2:

Sometimes, it's true, unawareness, because they haven't had a proper health screening, or they go to a clinician and they get an improper measurement and it's high and we just say, oh, it's probably okay at home, or you don't look like you should have hypertension, which is a horrible thing to say or to think. But often we discount sometimes high values for a lot of reasons and we just need to accept it's nothing wrong with having hypertension. It's just something we need to manage and we need to treat it.

Speaker 1:

Yeah, yeah, or what I think would like me, because typically what they say when they see it is oh well, let's just keep an eye on it. But then how many people are lost to follow-up care or don't keep an eye on it or don't go to their annual physical or whatever?

Speaker 2:

don't keep an eye on it. Or, you know, don't go to their annual physical or whatever.

Speaker 1:

So, yeah, yeah, keeping an eye on it would be fine if it really was keeping an eye on it.

Speaker 2:

Right Right, exactly, buying a blood pressure cuff, measuring it at home. So you get out of the white coat effect, but keeping an eye on it often means to some people I'll just come back in a year.

Speaker 1:

Exactly, exactly, and we'll see. And then, if it's high again, then I'll blame it on the white coat effect again and we'll keep an eye on it for another year.

Speaker 1:

Yeah, so, as we've talked about there, obviously a huge impact on public health in general then for all those untreated or undiagnosed cases and the impact that that's having on healthcare in general and costs, you know, admission costs of hospital and just healthcare costs in general. So so huge impact there. So let's talk a little bit about what are some recent updates in this space. So, has there been anything? You said there was a kind of a game changing thing about eight years ago or so. So what recently? Have we seen anything that's come up that's like, oh my goodness, make sure you're you're up to date on A, B and C or whatever. Not?

Speaker 2:

really. However sometimes something old is new again right.

Speaker 2:

So we had we had guidelines that were from 2017, great guidelines. They changed the blood pressure goals. We're not dealing with a whole bunch of new drugs. There's there's some bougie new drugs for resistant hypertension that are expensive, but we have so many drug classes that are cheap and generically available that we often, if you use the the mainstay drugs properly, you don't need them. But um 2017 was the last comprehensive guideline. There's one that's coming out this year, so in 2025, I'm not on the guideline group, so I'm not going to reveal any trade secrets, but I think they're probably going to reinforce the core messages.

Speaker 2:

Get people to the blood pressure goal. There's even more data now that achieving less than 130 over 80 with proper, accurate measurements is better than having people at higher goals unless you have somebody who's frail and elderly or near the end of their life that that tighter blood pressure control is more beneficial. They'll tell some of my docs that, and they don't always believe us. The biggest innovation that might come, though, is really the importance of home blood pressure measurement as a tool to get people to goal.

Speaker 2:

There's a reason that healthcare. I have strong opinions about things and I've closed my eyes, because when I think of PBMs in the healthcare industry. I sort of get sick to my stomach to some extent how it's been sort of turned into a business, but we have to accept that. But when they pay for things you know they're good. So they meaning the healthcare industry is incentivized to get people to blood pressure goals. We have quality metrics that look at report cards for health institutions. That's how we actually fund a lot of our clinical pharmacists to move those numbers down and it basically says the more people you have in your population who are controlled, the better care you're giving, the more money you make as a healthcare system.

Speaker 2:

So that says a lot because they don't give out money unless there's really good proof, because the consequence of uncontrolled hypertension is not only bad for your patient, but it's expensive to the health system. So maybe the biggest innovation that I see is really doubling down not only in the importance of home blood pressure measurement and monitoring, but allowing payment pathways so that clinicians can be reimbursed clinicians including pharmacists to get people the goal without having to bring them into the office all the time, because, as you mentioned, bringing people in the office is inconvenient, it incurs co-pays, it makes people nervous and if we can actually do it at home, there's pretty good data that managing people with home measurements and pharmacists are in this space.

Speaker 1:

I was going to say this sounds like a great opportunity. We're already kind of there, so yeah, yeah.

Speaker 2:

I mean, there's maybe some things that you hear about with renal denervation for very resistant patients, but heck, you know that's that's. I use the term bougie for some of the drugs, but those are sort of you know, not common patients that would do those procedures? No most people need basic good care and combination therapy.

Speaker 1:

Yeah, yeah, and I mean I'm just I'm hearing you know the opportunities for if a patient is not willing or not great at doing it at home, I mean where's the place that they go to most often? Their pharmacy. So that's a place where you know they can step up, and then also just the education from the pharmacist on proper technique can also be important. So, yeah, lots of opportunities that I'm hearing there in that space. If it is kind of the new thing is going to be really reinforcing checking it at home and monitoring your pressure at home, then I think pharmacists still have a big footprint in that space.

Speaker 2:

Yeah, those home devices have really gone a long way. They're very accurate and even the automated cuffs we don't use mercury manometers anymore. That went away a while ago. We don't use mercury in our measurement devices, but we have the same rules. When you mentioned appropriate blood pressure measurement, it's not hard. You follow some simple rules, you know.

Speaker 2:

Wait five minutes, put the cuff on bare skin, sit down, support your back, don't talk so those things that we do for a manual measurement apply to when people are doing it themselves or when a pharmacist, they can do a manual measurement, or they can actually use the automated cuffs too and just do it the proper way.

Speaker 1:

Yeah, no, that's great. So let's talk a little bit about, before we kind of get into deeper, of the opportunities for pharmacists out there and for our listeners to kind of take home with them. So let's talk about I feel like I've been a pharmacist now for almost two decades, which is mind boggling to myself. I can't believe it's been that long but and been in the space for another, you know aid on top of that as working as a high schooler and all that kind of stuff. But one of the things I feel like I've heard a lot lately kind of you know if we, if we want to tag it as a buzzword is individualized care or personalized care or whatever. Can we talk a little bit about that and maybe how that intersects with with hypertension management?

Speaker 2:

So yeah, I mean, when I hear personalized care I have sort of a guttural reaction because I think it is very trendy to say and some people automatically go down the space of pharmacogenomics and tailoring those drugs and we don't.

Speaker 2:

We don't need any of that with hypertension, but in a way, shouldn't every care be individualized? Any good clinician probably makes a patient-specific decision and includes the patient in that decision and using shared decision-making and letting the patient drive their own car. But I think that does fit into the space of hypertension. Even though we don't have genomic markers to guide us we don't need it we have multiple drug classes. We don't just have one drug that we need to use in everybody. We have our choice of usually multiple different agents or different drug classes, and it's good because we often need two or three drugs to get people to go. But individualizing care is everything from looking at patients' comorbidities to see if a drug favors treating that other comorbidity, or looking at side effect profile, risk, looking at other chemical markers like patients' sodium values or their potassium values or kidney values to help guide our therapy, sometimes even just.

Speaker 2:

You know, affordability is always something we should look at, but we're really looking at pretty cheap drugs unless we start getting to the, you know, some of the more expensive treatments for resistant hypertension, of which is very limited. So I think we still got Newer products without generics on the market quite yet, and there's really only, it's really only the newer stuff, because this is such a, you know, age, old, disease.

Speaker 1:

Yeah, yeah Things you know I would. I remember in my day some brand name hypertension medications, but I bet I'm sure even those are fully generic.

Speaker 2:

Now Everything's almost everything's generic, except for the brand new resistant hypertension drug, and there's a few more that'll hit. But you know ACE inhibitors, arbs, calcium channel blockers, diuretics, beta blockers. Sometimes we still use vasodilators like hydralazine. Even our centrally acting alpha agonists are all old and generic.

Speaker 1:

Yeah that's great. So that kind of takes us into kind of segues perfectly into the next topic, which is some opportunities. So there's hopefully then not a lot of economic disparities in treatment, so since most things are affordable, so let's kind of go down that path, as it's kind of that perfect segue. So are there what other opportunities and or challenges do we see in that space as far as, like barriers to care because of access or because of you know, cost or whatnot?

Speaker 2:

You know I don't want. I think I oversold the affordability end of hypertension because, even though they are very inexpensive generics that you can get, you know, online and Mark Cuban's cost plus drugs, or you can get them with discount cards some insurance companies like ours at the university of Colorado, if it's for preventive treatment you pay zero copay. But even cheap drugs can sometimes be problematic to patients that have limited resources or the cost of a copay can be preclusive to care for some people. Sometimes, it's you know, even if they have no copay, driving to a clinic can be a problem too. So I think that this is the best disease to look at for being affordable to treat. But we still have social determinants of health which give us the same old ugly results that you know it's unfortunate. People with the least amount of access sometimes tend to be the poorest treated for a variety of reasons that you know, multifaceted reasons, it's, you know cost of treatment, cost of accessory treatment, trying to eat well.

Speaker 1:

Well, yeah, we see the connection because if they if they have food insecurities, and then you know this is a disease that is highly affected by intake of food. Sometimes, obviously, there are genetic factors at play as well. But but yeah, I can see that. That can see that that further complicates matters, because if they're having one transportation insecurity or cost insecurity, then they're likely having a food insecurity and other things as well, which is just complicating.

Speaker 2:

Yeah, yeah, different community-based approaches to treat patients using interprofessional teams, including pharmacists and even actually other healthcare workers that might not be in a clear profession. Maybe they're outreach people that get people connected with clinicians.

Speaker 1:

And we are heavily in that space. I'll plug it really quickly, but we have been promoting now cross-training pharmacy technicians as community health workers and placing them in the community pharmacies for that connection to resources to try to make some of those connections increase adherence and improve outcomes. So, yeah, so let's talk a little bit about some additional opportunities for pharmacists in this space. So obviously it's important to stay up to date on guidelines those don't change as often it sounds as diabetes which are annual changes, but it does appear that you know changes are coming soon. So I think it's important to call out, you know we all need to be aware that check back later this year first part of 2026, whenever they come out, check back later this year, first part of 2026, whenever they come out, make sure that there's no earth shattering changes that we really need to be on aware of, right.

Speaker 2:

To just yeah, and it's always good to know about that, but I there's probably I mean, to my knowledge, there's really not that big thing that's going to come. That's going to change a landscape, like we see that in diabetes clearly we see that diabetes or kidney disease and all these diseases overlap. So when you see somebody with hypertension heck you know. Check their cholesterol. Make sure they don't have diabetes. If they have diabetes, it could be uncontrolled and they may develop kidney disease.

Speaker 1:

So it really is a vicious cycle that the population of people with hypertension so it's more really honestly for this patient population, because of so many comorbid conditions, it's more important to stay up to date on some of the other guidelines and make sure that you know, if your patient has this, that you're up to date on diabetes, and if they have this, then you're up to date on this. So yes absolutely.

Speaker 1:

What are some ways, some opportunities for us to increase adherence? Because you know, we've, you've talked and you've said many times patients who are I forget the word you use but basically resistant to treatment or to the patient.

Speaker 2:

So you know there's there's a lot of thoughts that go in my head. So how can we get people to be more adherent with their regimen? It's, it's not as easy as just take a pill once a day. Sometimes it's take multiple pills once a day, but it's almost. You know, we have lots of drugs in different classes and even within the same drug class there can be differences that are meaningful to your patient, whether it's frequency of dosing or incidence of side effects or, you know, drug interactions, those types of things.

Speaker 2:

I almost think it's sort of like was it Bob Ross that does the painting and he makes it look so easy. He's got all these colors and he just puts it together up there. It's almost like hypertension. Each drug class is a different color, but you have different shades of blue and you know one a light blue might be better than dark blue, but a good clinician like Bob Ross could put it all together and make it look good. But when I'm up there I'm like I don't know, I can't make it look good because I I'm not trained and I'm not an expert in there. So I think you know how can we help patients, you know, make all the colors work, which are all the antihypertensive drugs, along with their lifestyle modifications. Sometimes it really is, and this is where pharmacists are good is if they have time to really, you know, get to know your patient, know what they're thinking, what their real experience was.

Speaker 2:

I think of my mother-in-law. She has reactions to anti-hypertensive medicines that don't make sense to me but they're real to her Right? She always thinks that her Norvast she calls it, her amlodipine, makes her drowsy. Probably isn't making her drowsy because she thinks it's making her, you know, their blood pressures high. She's gone to the ED. Even though I try to keep her out of the ED, she goes very frequently for because she doesn't feel good. But sometimes people, despite what we know, like scientifically to not be. Our reality is their reality. So you have to be nimble and you have to, you know, find a different shade of blue, find a different drug. Maybe it's in the same drug class, maybe it's another one. Sometimes it's people teaming up two pills, two drugs, in one pill, so we underutilize combination products. So once you've done titrating, make it easy for your patient, put the two. I mean, that's what hydrocortisides with just about every other major antihypertensive.

Speaker 1:

So it's there. For a reason we even have some three drug combination products that are generic but sometimes it can be expensive.

Speaker 2:

But there's a pill burden thing. Sometimes people in their head they think, oh, if I'm on three it's really bad.

Speaker 1:

I'm embarrassed. Yeah, they shouldn't be embarrassed. Yeah, or I, or it's not even worth me taking them anymore, cause I'm so far gone. That's right.

Speaker 2:

Yeah, that's so unfortunate that they think, oh wow, you know it's not going to, what's a fourth drug going to do? But some people need that fourth drug and they don't realize the incremental benefits. And the incremental benefits and if they do have whatever's real I mean even if I don't believe it- it's real to your patient.

Speaker 2:

If it's like a side effect or some kind of policy notion and you got to work around it, you can try re-educating if you don't think it's a real thing. And if that doesn't work or if it is real to your patient, you just move on and go to something else. Knowing our options and knowing what steps two, three and four are really important. I work with wonderful docs that know what they're doing and PAs and nurse practitioners, but sometimes you know they need help. You know managing a med list and going through this patient's head. Like you know, I call it the pharmacophobia where they have like a long list of fears of many drugs and they've had this side effect, this side effect, that side effect and you know we're good at actually understanding that language and trying to put it together and finding maybe the one that they haven't tried or one that is less likely to cause the same problem.

Speaker 1:

Well, and like you said earlier, you know, with a comorbid condition, there are some medications that are needed because of renal insufficiency or because of diabetes or whatever. So we also can be that conduit, as well as the medication expert, to say, hey, let's go to this one as option two, because it's also going to benefit this as well, or something.

Speaker 1:

Oh, yeah, and then you know another thing I remember you know doing when I had my store. What was really important was again that burden or the not necessarily even you know taking two, but like taking it multiple times a day. So looking for the opportunities where there might be an extended release formulation and you could get, you know, someone transferred over to that, and so there are opportunities there too, I think, where the pharmacist can kind of really come into play and say hey, the adherence is low. Maybe it's because we're having them take it three times a day. Why don't we just do it once a day or whatever?

Speaker 2:

And sometimes we still see bad habits. Every once in a while you see somebody who's on clonidine who hasn't tried other first-line drugs, or they're on atenolol instead of a better beta blocker, or they're on metoprol tartrate when they could be on succinate and take it once a day yeah, exactly, exactly, um, and you mentioned collaboration with other providers and I think that that's something.

Speaker 1:

Obviously we could have a whole podcast just on interprofessional collaboration, whatever, but that's certainly another opportunity there is to make sure that that you know, we as a as a profession, as pharmacists- is inserting ourselves into that space and making sure that we are collaborating and we're communicating and and you know, don't assume that the person treating your hypertension also knows the patient has A, b or C, like you know. We need to be sure that we're communicating that, and I think that's important to keep the line of communication open. So, yeah, so let's talk a little bit about challenges before we already run out of time.

Speaker 1:

I don't understand how time always goes so fast. It's a good thing. It means that we have lots to talk about, but let's talk quickly about just what are some of the challenges that we're going to face. So I think adherence is an opportunity for us, but it also is a challenge, and so let's briefly touch on complex cases. So what are some of those where you're like gosh, this person needs four different meds? You know like how, maybe kind of walk us through what those look like, or how we kind of overcome some of those challenges.

Speaker 2:

Yeah, it's probably your patient with resistant hypertension, because I think there's some people would answer this. They say, oh, the people with complex kidney disease or complex heart disease.

Speaker 2:

But often if you're treating those comorbies, they treat the hypertension trues. So there's a sort of a hit two birds with one stone kind of attitude there. But patients that have resistant hypertension it happens to a lot of them. The definition of resistant hypertension are patients who require four medicines to manage their hypertension, even if it's not controlled, or patients that are on a good three-drug regimen which has a diuretic like hydrochlorothiazide, an ACE inhibitor or an ARB and a long-acting calcium channel blocker like amlodipine.

Speaker 2:

If that doesn't do it at good doses, then you have somebody that's resistant to hypertension and it doesn't mean that they're abnormal, that they have some other disease. Maybe they make too much aldosterone and what we do in that population is we have to be comfortable with adding the fourth drug. Four sounds like a lot but it's not for patients who are taking their medicines and need it, and there's a lot of people out there, whether it be something that blocks aldosterone, like spironolactone, or even using a beta blocker if appropriate or some of the other agents that are less frequently prescribed, I think really a resistant hypertension population is it. And then really doubling down and helping to identify any lifestyle modifications that can do that might help out whether it's drinking too much alcohol or being overweight, which are obese, or having obesity or having overweight status really could be a challenge.

Speaker 1:

Yeah, and you know that takes me into the next one. What are your thoughts on getting obesity under control and a hypertensive patient with a GLP Like what? What are your thoughts?

Speaker 2:

Yeah, you know, um I I'll start this by saying nothing. Nothing works better for blood pressure and weight loss and somebody who needs weight loss, so people who have obesity the more weight you lose, the more reduction you get in blood pressure. So really it's good for a whole bunch of spillover effects. Um, I think you know there's so much noise and new information with glp1s. There's more around the corner, like dual and triple agents that will be available that affect incretin hormones and other um, they call them noosh nutrient stimulated hormones. That's like the new term from going beyond just glp-1 um, where they have their significant benefit. Um, they're still I'm I'm a supporter. Uh, I don't.

Speaker 2:

I still think there's a lot of other things that we can do, but I don't want to discount that they, they work and when people lose weight, their blood pressure goes down, sure, um, if they have hypertension and they have overweight or obese status, uh, so you know, it's something that that's. It's sort of sad that when patients hear glp1, they're like most people, like ah, but when they hear hypertension treatment they're like. And they hear statin things they're like most people, like ah, but when they hear hypertension treatment they're like and they hear step and things they're like oh oh, yeah, I probably don't need that.

Speaker 2:

Yeah, they're like I heard about this, but yeah, so you know, right now people are smiling with glp-1s. Maybe it'll be a time when they don't smile as much as far, you know, they're not, they're not cheap um, they do, they work.

Speaker 1:

They're not. They're not super fun to be on. You know they have some-. People do have side effects.

Speaker 2:

Side effects yeah, it's funny. I saw a report that people who have diabetes have a better chance of tolerating the drug than people who do not have diabetes.

Speaker 2:

Those drugs there's been reports about how, based on randomized trials and how, there's a higher discontinuation rate in non-diabetes obese patients than in people with diabetes on the GLP-1s, for whatever reason. So we're still I say that because that's not implicit but we're still learning about that drug class. I really am a supporter, but I and everything seems to be coming up roses as far as kidney benefits, heart failure and cardiovascular risk, but it's something that's part of our thought process.

Speaker 1:

Yeah, Well, and I think you know, I think what, what is key there is just remembering that lifestyle modifications are a component of hypertension management.

Speaker 1:

So I think that is is also key, and whether or not it's, you know, getting the weight off with the addition of a GLP-1, or whether it's just talking and reinforcing nutrition and exercise and things like that. So, yeah, well, that brings us to our time almost. So, before we run out of our time completely, one thing I always like to do, joe, is just give our speaker a chance to kind of summarize what we talked about, like in true form of what our podcast is called, is Game Changers. And so what's the game changer here? What do our learners need to take away from this episode?

Speaker 2:

One hypertension is very common and even if you don't know you have it, you might have it. Make sure your patients know that. Two there's lots of good treatments lifestyle and drug therapy and they're underutilized, they're underdosed, underprescribed, especially those fixed. Those combination products may really resonate with a lot of patients. And three help your patients understand the truth and throw out that term. Never use the term polypharmacy, put it in a box and burn that box, because polypharmacy always implies bad things. But you need multiple drugs in most patients with hypertension. It's nothing for patients to be embarrassed about. It's something that you should be aware of upfront and sort of anticipate that they may need two or more medicines.

Speaker 1:

Yeah, that is again. I feel like we could go for about 30 more minutes on that whole topic. So thanks for opening that Pandora's box. It'll be a good one to continue talking about, Because that's a great point. We talk about how polypharmacy get rid of it. It's so bad, whatever, but that is sometimes putting a negative connotation on the fact that you are going to need multiple medications for hypertension.

Speaker 2:

Yeah, wow, yeah. I have met people who have lost a significant amount of weight and have not required some of their anti-hypertensive medicines. So some things can happen, but that's not the common situation yeah, but that's that's an interesting perspective.

Speaker 1:

So thanks for thanks for opening my eyes to that, I'm sure it opens some listeners eyes as well. So again, as I mentioned, that's all we have time for. Thank you, joe. So much, so much.

Speaker 2:

Thank you.

Speaker 1:

So great. I really appreciate you giving us your time.

Speaker 2:

You're welcome.

Speaker 1:

If you're a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at ceimpactcom. And, as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you all next week.