RPhCast, Episode One: Statins, Blood Pressure, and Curves Galore

Drug Topics: Hello, and welcome to today's episode of RPhCast. Today, Kevin and Donna are going to educate you on a whole lot of stuff, including the importance of statins, how to better utilize drug therapy in regard to blood pressure and cholesterol levels, remind you about the J curve talk about data surrounding older patients. And really just look at how to take a more nuanced look at blood pressure levels. And still even more than that, so we won't take up too much of your time. Here are Kevin and Donna.

Kevin Walker: Hi everybody, it's Kevin and Donna from RPhAlly, we're super excited to be here with you. I even wore my scrubs. But we're talking a little bit about being able to bridge the gap between helpful and harmful and where to kind of work things in, so that's why you should stay tuned. We're jumping into statins, one of those kind of hot button things to talk about. And we'll jump in and we'll get we'll get wild with this one talk to you soon. Okay, so speaking of wild, Donna, it's wild to me sometimes when I am seeing patients that are saying I am lightheaded, Kevin, I struggle to be able to get up in the mornings, my volition levels are down, and then you and I look at their blood pressure overall and well, they're somewhere around 100 over 60. And then they're getting up and they're falling, or they're breaking hips. So to me, it is wild, that we're utilizing drug therapy so poorly to push them that direction. And you're gonna tell us a lot more about that and connecting that in to statins. Right?

Donna: Yeah. So I think we first have to start thinking about the J curve, right? And people that I've been talking with, especially younger practitioners, like, What are you talking about? So remember, the J curve, everybody, if not listen in. And let's, let's review this. So when we're thinking about the J curve, that's really all about blood pressure. And we're looking at what's ideal. And with this particular graphic, you can see that there's an actual age where we really start thinking about where somebody's blood pressure should be and where that J curve moves. So when we're thinking about how low a blood pressure should be, we have to be careful, right? We, we want people to have good blood pressures, but we can't have them be, you know, going so low. So there's often been this thought process of less than 60 millimeters of mercury might get a little touching go. And we do know that especially when we are looking at our older adults, when we're looking at, folks, we really have to be very careful of how low we their blood pressure is going. So we don't want them to end up falling, having more of hazard issues when their diastolic is less than 60. Now the systolic we can also see that there's this change to in where blood pressures are going. So we know that a high systolic range is not good. But how low can we actually go for this lower range. And when we're looking, it's actually we shift it right, we shift a little bit more to the right. So we like for younger folks. We like the blood pressures to be around the 120s or less than 120. But as we're older as we age, and we're getting more into the, you know, 70s or 80s, or 80s. We don't want to go that low. That's when people are falling too, and when there's more and mortality issues. And so we really have to be careful about the age of the person and where we're targeting to treat. So as we know, when we're looking at older adults, and Kevin, you said it, you know, they're standing up or they're getting up in the middle of the night and they're falling. That's that whole orthostatic hypotension. But what are we treating to people's goals are changing, and we have to teach people that 120 over 80 might not be ideal, or 120 over 70 or 110 over 60 is not ideal for you. We we don't want you on three or four blood pressure medications anymore because they're not safe for you. I just did a really interesting talk today. It was called overlook University and trying to teach older adults who live in an older adult community. They actually have this coin University and they're teaching people constantly about better health and it was their health segment that I was teaching at today at this overlook University of my 65 and olders that attend Did my class. And it was great, because they were learning that, you know, there comes a time when we retirements. So, so looking at the J curve is a start. And now let's think about this further. Don't you think there's other J curves? Right? As we move through, we know like hemoglobin a one sees, we can those shift to the right as well, for older adults, we don't have to go so low. We don't want lots of lows. What about statins? Who talks about how low statins can go? And I don't think we really have a good answer. There's a lot of controversy. But I've been doing some digging and doing some studies. And I've been seeing some crazy lows. Cholesterol levels at the hospital. And I have to say, I'm in shock, sometimes with the numbers I'm seeing, and why are we still on these high intensity, cholesterol meds when were 85 and 90? We know that the the actual guidelines only really go up to 75. And it works. What do we do after that? So let's make some sense out of this, let's look a little bit deeper. And so go into my channel. And we're going to talk about the actual statin side of things and look at some you curves.

K: We had a question, Donna. And it was Chris joining. And she said just joining this point may have been made, but what age are older, is there a reference the oldest of the old inside of there. And then just to reference back to our graphic there, Chris, is that really when you're looking at the J J curve, that separation, when you see those data points change happens right around the age of 70, you know, some of our data goes up to the age of 75, we start to see that kind of split happened right right around there that we start to have more problems. And we're pushing stocks in particular, lower at the age of 70. Below that 140 mark, and we start to see some problems. But Donna any other commentary, I guess, on the what age or older that you're seeing in most data and research, because we always talk about 12 and up, you know, we always hear that in the pediatric side of things like that's where we have data, where's the stopping point for us in the geriatric world. And then when Chris is referencing the oldest of the old, I guess I'd love to hear your kind of thoughts on. We always talk about Jacobs and give a solid number. But you and I know that within the 72 year old population with an 80 year old population, we have much healthier, more active individuals that have a different body composition, etc, in that space. So can you break that down a little bit for us, Donna?

D: Yeah, so there, of course, is the actual chronological age that we're looking at. But we really have to be looking at the person themselves. And are they healthy, what's their frailty score, and a lot of what we're learning now is that frailty is going to play a big factor in how we look at people and, and how we decide about treatment. So age and frailty are really going to go hand in hand. So So with that said, I also want to say that a lot of the guidelines, you'll see people who have been parts of studies that are up to 65, or greater than 65. And then we tend to see the 75, in older, or we'll see 75 to 80, or 75, to 85, and then 85 and older. So there's different groupings in different studies will will separate out accordingly. But within that, you can also see the comorbidities that are listed in other demographics of the groups. So, so actually for cholesterol 75 is kind of a magical number for me, because when I'm teaching students, we don't really have information beyond that. We don't know too, whether or not we should be starting a stat and then I can tell you, I see high star high stat and started all the time at the hospital, if necessary. But is that right? And we're starting to see some treat targets too. I have a student actually doing a research project right now, for this year. And we're hoping to have a poster together by the by the end of this year regarding all of this information. So So thinking about all of this, like, where are we at and what should we be doing? It's very controversial. There's also studies out there that show people over the age of 75 who have stopped their statins and this is just an observational study, but they just decided to stop their statin medications. And there was a high risk of hospitalization in those 75 year old and older folks who actually stopped their stat and within two years they ended up with a cardiovascular sort of event that caused them to be hospitalized. So that's another study that we have to be kind of going through and seeing what's going on with cholesterol is there.

K: I love that you bring that up Donna, because the interesting thing that happened was smokers too, you know, a lot of later stage in life, smokers that quit. Or they see some problematic things that happen when blood pressure control, especially if there's an atrial fibrillation kind of connected in the equation, but they're starting to see those problems. And it's, it makes it more difficult knowing that something could be problematic or could not be advantageous, and then pulling that off and realizing that something has already been set, in course, for the way the body is adjusted to any given drug or stimulant. And now we still have to be able to course correct or that time and do it safely. So, everybody, if you're excited to learn more about the statin you curve, you know, and how we're kind of looking at the new data coming out in statins and how low we're pushing some of those numbers. All set up everything inside of the channel and you'll jump over to RPh li go on the D prescribing channel and then you can join Don and I there. We're really excited to see you guys. Don any parting words for the audience?

D: Just come join me learn about you curves and there's way more curves than we can even dream of.

K: Love it. Let's get curving, and we'll talk to you then.

DT: And that just about wraps things up here. Thank you so much for tuning into this episode of RPh cast a collaboration podcast between RPhAlly and Drug Topics. Keep an eye out for a new episode. We got a ton of good content coming soon and we can't wait to see you again. Have a great day.