Episode 245 -- January 2026 -- Part 1 AFP: American Family Physician

Summary

AFP Podcast Episode 245 – January 2026, Part 1

Date: January 15, 2026
Hosts: Jake Anderson, Emily Eisenberg, Kari Staus, Justin Chediak
Contributing Editor: Dr. Steven Brown

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Episode Overview

This 10th anniversary episode of the AFP Podcast brings together faculty and residents from the University of Arizona College of Medicine–Phoenix to review clinical highlights from the January 2026 issue of American Family Physician. The hosts deliver evidence-based updates on recently approved medications, practice guidelines, and the latest studies in family medicine. Key topics include a new acid-suppressing drug, strategies for newborn respiratory distress, updated vaccination schedules, calcium supplementation in pregnancy, resistant hypertension management, and emerging blood-based colorectal cancer screening tests.

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Key Discussion Points & Insights

10 Years of AFP Podcast: Reflection and Milestones

• Celebration of the Podcast’s 10th Year:
  • The hosts open with reflections on a decade of podcasting (00:29).
  • Steve Brown: “As of this morning, the podcast has been downloaded 8,440,802 times to be exact.” (01:07)
  • Jake Anderson: “It’s hard to believe that what started as a wild ride has now been happening twice monthly for 244 episodes.” (01:00)
  • Team highlights include launching the Spanish-language Revista Médica (2022), over 60 resident hosts, and ongoing community support.

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New Medication: Vinoprazan for Acid-Related Disorders ("STEPS" Review)

Segment starts: 03:22

Mechanism & Indications

• Emily Eisenberg:
  • “Vinoprazan, brand name Voquezna ... is labeled for healing and maintenance treatment of erosive esophagitis and heartburn associated with erosive esophagitis as well as treatment of GERD and as part of triple therapy or double therapy for H. Pylori.” (03:57)

STEPS Framework

• Safety: Risks are similar to other long-term acid suppressants—examples include risk of fractures, C. diff, B12 deficiency, low magnesium, and caution in severe renal or liver impairment. (04:30)
• Tolerability: Comparable discontinuation rates to lansoprazole (0.9–2.3%). (04:59)
• Effectiveness:
  • Comparable to lansoprazole for healing erosive esophagitis.
  • Superior to placebo for non-erosive GERD (NNT = 6 for symptom-free status at 4 weeks).
  • More effective than lansoprazole triple therapy for H. pylori, especially in clarithromycin-resistant cases (NNT = 3 in resistant cases). (05:41)
• Price: $200/month vs $15–$30 for lansoprazole. (06:03)
• Simplicity: Once daily; can be taken with or without food. (06:18)

Bottom Line

• Kari Staus:
  • “Vinoprazan is superior to placebo for treatment of non-erosive GERD ... and more effective than lansoprazole triple therapy for eradication of H. Pylori.” (06:25–06:36)

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Newborn Respiratory Distress: Evaluation & Management

Segment starts: 06:45

Epidemiology & Recognition

• Up to 10% of newborns need respiratory support, ~5% require advanced resuscitation. (06:57)
• Signs: Grunting, nasal flaring, retractions, RR > 60.
• Main risk considerations: Gestational age, amniotic fluid, maternal/perinatal factors, and umbilical cord management. (07:27)

Initial Management

• Begin with drying, stimulation, and airway positioning.
• Positive pressure ventilation if HR < 100 or apnea/gasping; escalation per neonatal algorithm. (07:51)

Case-Based Differential

• TTN (Transient Tachypnea of Newborn):
  • Classic after elective C-section, especially with macrosomia/gestational diabetes (incidence up to 30%).
  • Self-resolving; supportive care only. (08:33)
• Meconium Aspiration Syndrome:
  • “More common in near/post-term infants ... routine endotracheal suctioning is no longer recommended ... management is also supportive.” (09:29)
• RDS (Respiratory Distress Syndrome):
  • “Most commonly presents in premature infants due to immature lungs and surfactant deficiency ... symptoms worsen over first 48 hours.” (10:26)
  • Use of maternal corticosteroids (24–36+6 weeks) reduces risk.
• Infectious causes (Pneumonia):
  • Hard to distinguish from sepsis; high mortality. (11:08)
• Other:
  • Congenital (cardiac, diaphragmatic), metabolic, or airway abnormalities. (11:39)

Takeaway

• Kari Staus: “Early recognition, stabilization and keeping a broad differential are going to be keys to optimizing outcomes for these newborns.” (12:02)

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Immunization Update: 2025 Recommendations

Segment starts: 12:12

• AAFP’s 2025 immunization schedule differs in several ways from the CDC’s, notably strengthening recommendations for COVID-19 and influenza vaccination in children.
  • COVID-19:
    • Universal vaccination for children 6–23 months and high-risk 2–18-year-olds. (12:57)
    • Vaccine type by age: Moderna (<5), Pfizer/Moderna (5–11), and Novavax options (12+). (13:19)
    • CDC recommends shared decision-making; AAFP favors universal approach.
    • Recommends COVID-19 vaccination during pregnancy.
  • Influenza:
    • CDC recommends only single-dose vials (thimerosal-free).
  • Pneumococcal:
    • Vaccinate all adults ≥50 (previously 65+). (14:42)
  • Meningococcal:
    • New PenMeNV vaccine covers Groups A, B, C, W, Y. (15:11)
  • Chikungunya:
    • Vaccine for travelers to epidemic areas or long-term stays in at-risk countries. (15:34)
  • RSV:
    • Expanded RSV recommendations for 50–59 year-olds at risk and new monoclonal antibody options for infants. (16:00)

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Calcium Supplementation in Pregnancy: Beyond Preeclampsia

Segment starts: 16:39

Research Overview

• Cochrane review of 19 RCTs (16,000+ pregnancies) on calcium’s effect on non-hypertensive outcomes (e.g., preterm birth, low birth weight).
  • Calcium may slightly reduce late preterm birth (RR 0.8; minor absolute benefit).
  • Little/no effect on earlier preterm birth, low birth weight, maternal/fetal adverse outcomes. (17:40–18:26)
  • No increased risk of harms (GI, kidney stones, anemia). (18:26)

Practice Implications

• Justin Chediak:
  • “Calcium supplementation is still best supported for preeclampsia prevention in patients with low dietary intake.” (18:50)

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Resistant Hypertension: Evaluation & Optimizing Management

Segment starts: 19:17

Definitions

• Hypertension: Office ≥140/90, Home ≥135/85, 24-hr ≥130/80. (19:31)
• Resistant hypertension: Uncontrolled BP with 3 optimal agents (one a thiazide diuretic). (20:01)

Accurate BP Measurement

• Multiple steps to ensure correct readings (cuff size, position, rest, caffeine/nicotine abstinence, empty bladder, no talking). (20:31)

Treatment Approach

• Lifestyle:
  • Exercise reduces SBP by 4–9 mmHg; DASH diet by 8–14; 10kg weight loss by up to 20 mmHg. (21:26)
• Medication:
  • Prefer combo low-dosage over maxed monotherapy—adding a second agent is ~5x more effective. (22:02)
  • After CCB/ARB/ACE/thiazide, next add mineralocorticoid antagonist if still uncontrolled. (22:23)

Summary Quote

• Jake Anderson:
  • “If your patient’s blood pressure is still above goal, the preferred fourth agent to start is a mineralocorticoid receptor antagonist.” (22:45)

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DNA-Based Blood Test for Colorectal Cancer Screening

Segment starts: 23:28

Study Review

• 27,000 patients: Blood test vs colonoscopy.
  • Detects ~80% of colorectal cancers (esp. stage 2–4). (24:02)
  • Major Limitation: Only 12.5% sensitivity for advanced adenomas (pre-cancer), much worse than FIT stool test.

Clinical Implications

• Concern: False reassurance, potential reduction in use of proven screenings (FIT, colonoscopy), possible negative effect on CRC prevention and outcomes. (24:23)
• Emily Eisenberg: “Bottom line, despite impressive numbers on paper, this blood test isn’t ready to replace existing screening... stick with what we know definitely saves lives.” (24:38)

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Notable Quotes & Memorable Moments

• On Podcast Longevity:
  • Steve Brown: “...didn’t even know after the very first pilot that this would happen at all.” (01:07)
• On Transitional Newborn Care:
  • Emily Eisenberg: “Even umbilical cord management can really impact how smoothly a newborn transitions after birth.” (07:27)
• On Medication Costs:
  • Jake Anderson: “The cost of vonoprazan is approximately $200 for a one month supply. In contrast, a one month supply of lansoprazole costs approximately 15 to $30.” (06:03)
• On Hypertension Management:
  • Justin Chediak: “The addition of a second antihypertensive agent is five times more effective at lowering systolic blood pressure than doubling the dose of the original agent.” (22:02)
• On CRC Screening:
  • Emily Eisenberg: “Screening is about preventing cancer, not just detecting it late.” (24:23)

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Timestamps for Key Segments

• Podcast milestones and community reflections: 00:29–02:23
• Vinoprazan STEPS review: 03:22–06:45
• Newborn respiratory distress: 06:45–12:12
• Immunization guidelines update: 12:12–16:12
• Calcium supplementation in pregnancy: 16:39–19:03
• Resistant hypertension management: 19:17–22:45
• DNA-based colorectal cancer screening: 23:28–24:57

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Tone & Style

The hosts maintain a conversational, collegial, and occasionally humorous style, mixing puns, clear teaching points, and personal perspective. The tone is engaging but always grounded in evidence and practical advice.

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This summary captures the full sweep and spirit of AFP Podcast Episode 245, delivering key clinical updates and practice-changing pearls for busy family medicine clinicians.

Transcript

[Podcast Host/Announcer]

The AFP Podcast is brought to you by the American Academy of Family Physicians and by Elation Health. Elation is an AI powered EHR that helps primary care practices spend less time on documentation and admin tasks and more time on what truly matters, caring for patients and nurturing meaningful relationships. Information is [e-mail] AFP Hey, Jake.

[Jake Anderson]

Happy New Year. Steve. We never get to record together what's going on.

[Kari Staus]

I know.

[Steve Brown]

Well, the AFP podcast recently hit a significant milestone. Our 10 year anniversary. How many podcasts do you know that have gone for 10 years?

[Jake Anderson]

Oh, my gosh, I can't even tell you. That's amazing. It's hard to believe it's been a decade. Let's see. So November 2015 is when we hit the airwaves. Can I say airwaves?

[Steve Brown]

Even though definitely no one will know what you're talking about. But regardless, we really wanted to thank everybody, our listeners, for tuning in over these past years.

[Jake Anderson]

It's hard to believe that what started as a wild ride has now been happening twice monthly for 244 episodes.

[Steve Brown]

Yeah, we didn't even know after the very first pilot that this would happen at all. And as of this morning, the podcast has been downloaded 8,440,802 times to be exact. And there's been a lot of highlights over the years, from delivering great AFP journey content to interviews with family medicine.

[Jake Anderson]

Leaders, and from like really bad puns to really good puns.

[Steve Brown]

I don't know how many good puns we've had.

[Jake Anderson]

That's fair. But also launching Revista Medica, the Spanish language version. That was a big highlight that happened in 2022. It's been such a pleasure to be part of it.

[Steve Brown]

Yeah. And 60 resident hosts have joined us, which is absolutely amazing.

[Jake Anderson]

It's incredible.

[Steve Brown]

And we couldn't have accomplished any of this without the support of the American Family Physician team. And most importantly, all of you. Our listener enthusiasm has really kept us motivated. We're deeply grateful for each of you who tune in week after week.

[Jake Anderson]

And we can't promise fewer bad jokes, but we can promise to continue to bring you more of the excellent evidence based content from the American Family Physician Journal.

[Steve Brown]

Yeah. Thank you everybody for being part of our AFP podcast family. And cheers to the next chapter together.

[Jake Anderson]

Happy New Year, everyone. Foreign. Welcome to the American Family Physician podcast for part one of the January 2026 issue. I'm Jake.

[Emily Eisenberg]

I'm Emily.

[Kari Staus]

I'm Kari.

[Jake Anderson]

And we are residents and faculty, mostly residents though, of the University of Arizona College of Medicine, Phoenix Family Medicine Residency Programs. Today on the podcast we'll talk about Vinoprazan, newborn respiratory distress immunization schedule, recommendations from the AAFP calcium supplementation, resistant hypertension in adults, and DNA based blood tests for detecting colorectal cancer.

[Emily Eisenberg]

The opinions expressed in the podcast are our own and do not represent the opinions of the American Academy of Family Physicians, the editor of American Family Physician or Banner Health. Do not use this podcast for medical advice and instead see your own family doctor for medical care.

[Jake Anderson]

We're on a Mission Delivering the Best from American Family Physician On a Mission Delivering the Best from American Family Physician first up, we have a Steps and guys, I'm extra excited about this. I don't mean to brag, but I know the authors of the Steps. That's right. AFP Podcast musician Dr. Bill Dabs is joined by his pharmacist partner Dr. Chamberlain to bring us this Steps on Vinoprazan Exactly.

[Emily Eisenberg]

Vinoprazan, brand name Voquezna, works by inhibiting the hydrogen potassium ATPase enzyme to suppress gastric acid secretion and is labeled for healing and maintenance treatment of erosive esophagitis and heartburn associated with erosive esophagitis as well as treatment of GERD and as part of triple therapy or double therapy for H. Pylori.

[Jake Anderson]

Let's walk through the steps because this is a new medication to me at least. Remember, STEPS stands for safety, tolerability, effectiveness, price and simplicity. So we'll kick it off with safety.

[Kari Staus]

In general, it seems to be a safe medication. Concerns are similar to other long term acid suppression which include risk of osteoporotic fractures, c diff associated diarrhea, vitamin B12 deficiency and hypomagnesemia with associated hypocalcemia and hypokalemia. Caution should be taken in those with an estimated glomerular filtration rate less than 30 mils per minute or a child pugh class B or C liver impairment.

[Jake Anderson]

Next up, tolerability.

[Emily Eisenberg]

In general, vinoprazan is pretty well tolerated. Discontinuation rates are similar to those of treatments containing lansoprazole with rates ranging from 0.9% to 2.3%.

[Jake Anderson]

E effectiveness it is effective.

[Kari Staus]

Outcomes are similar when comparing vinoprazan to lansoprazole in endoscopy confirmed erosive esophagitis, healing rates, maintenance rates of healed erosive esophagitis and in percentage of heartburn free days in patients with healed erosive esophagitis for the symptomatic relief of heartburn. In non erosive GERD, vinoprazan at 10 milligrams per day was superior to placebo with a number needed to treat of six to be symptom free through four.

[Emily Eisenberg]

Weeks and for eradication of that tricky H. Pylori treatment with vinoprazan 20mg plus amoxicillin and clarithromycin was more effective than lansoprazole triple therapy for all patients with H. Pylori infection with a number needed to treat of nine as well as for those with clarithromycin resistant H. Pylori with a number needed to treat of three.

[Jake Anderson]

What's the price?

[Kari Staus]

The cost of vonoprazan is approximately $200 for a one month supply. In contrast, a one month supply of lansoprazole costs approximately 15 to $30.

[Jake Anderson]

Okay, alright. And lastly, simplicity.

[Emily Eisenberg]

Vinoprazan is a once daily oral medication that can be taken with or without food.

[Jake Anderson]

All right, Kari, bottom line it for us.

[Kari Staus]

Okay Jake, the bottom line. Vinoprazan is superior to placebo for treatment of non erosive GERD as effective as.

[Justin Chediak]

Lansoprazole for treatment of erosive esophagitis and.

[Kari Staus]

When combined with amoxicillin and clarithromycin, more effective than lansoprazole triple therapy for the eradication of H. Pylori.

[Jake Anderson]

Next up, we have a main topic, newborn respiratory distress evaluation and management. And it comes to us from doctors Buhl and Gold from Indiana University School of Medicine in Indianapolis.

[Emily Eisenberg]

Up to 10% of newborns require some form of respiratory support after Delivery and about 5% need more advanced resuscitation.

[Kari Staus]

So.

[Emily Eisenberg]

So it's super important for anyone caring for newborns to recognize and manage respiratory distress.

[Justin Chediak]

Yup.

[Kari Staus]

Unfortunately, most of us have seen a newborn in respiratory distress with increased work of breathing. As a reminder, this can present as grunting, nasal flaring or retractions and a respiratory rate above 60. Because the differential is broad, what should we keep in mind for all deliveries to be ready for respiratory distress?

[Emily Eisenberg]

Emily so there are a few big ones. Gestational age, amniotic fluid color, and both antepartum and intrapartum factors like maternal conditions, delivery method or infection. All super important. Even umbilical cord management can really impact how smoothly a newborn transitions after birth.

[Jake Anderson]

What initial steps should be taken for all newborns and what changes if respiratory distress is present?

[Emily Eisenberg]

Standard care starts with drying, stimulating and assessing breathing. If distress is present, drying and stimulation should continue While the baby is kept warm, the airway is positioned and secretions are cleared. If the heart rate is under 100 beats per minute or if there's apnea or gas bang, then positive pressure ventilation, ideally with a T piece device, should be started after suctioning. Further escalation follows the neonatal resuscitation algorithm.

[Justin Chediak]

Let's talk about a few cases. Say you're called about respiratory concerns in a two hour old newborn born via elective C section after pregnancy complicated by macrosomia and gestational diabetes with clear amniotic fluid. What's in our top differential?

[Emily Eisenberg]

Oh boy. Well that's a classic setup for transient tachypnea of the newborn or ttn, something we've all dealt with on our newborn services. Incidence is as high as 30% for term babies born via elective C section. It's caused by delayed clearance of lung fluid and usually occurs two to six hours after birth. On exam you might see a barrel shaped chest from hyperinflation and a chest X ray can show some prominent perihiler vascular markings. Management is supportive and treatments like albuterol, furosemide fluid restriction haven't shown any clear benefit. Most infants improve within 48 hours and it's important to remember this is a diagnosis of exclusion so other differentials definitely need to be considered helpful.

[Jake Anderson]

Alright, let's change that case a little bit. So say instead of an elective C section it was an emergency C section for non reassuring heart tones and there was thick meconium noted. What would you be concerned about then?

[Emily Eisenberg]

Definitely meconium aspiration syndrome which occurs in 3 to 12% of infants born through meconium stain fluid. It's definitely more common in near post term infants since the fetal GI tract actually doesn't contain meconium before 34 weeks. Aspiration causes airway obstruction, inflammation and surfactant inactivation. These infants can have meconium sane skin and also have a barrel shaped chest. From that air trapping the chest X ray can show some patchy infiltrates or atelectasis, but it's important to remember that these findings don't necessarily match severity and routine endotracheal suctioning is no longer recommended for these babies given it doesn't reduce the risk and complications can occur. Management is also supportive and positive pressure ventilation might be needed.

[Jake Anderson]

So I remember that RDS or respiratory distress syndrome can be a complication of meconium aspiration. And how does RDS usually present?

[Emily Eisenberg]

Definitely it can certainly be a complication, but actually most commonly RDS will present in premature infants due to immature lungs and surfactant deficiency. Unlike TTN, symptoms worsen over the first 48 hours. Chest X ray may show a ground glass or whiteout appearance. Management includes supportive ventilation, again as brief as possible to limit bronchopulmonary dysplasia risk as well as surfactant therapy. Maternal corticosteroids given before delivery significantly reduce the risk of RDS and are recommended for those at risk of preterm delivery. Given between 24 and 36 weeks, 6 days gestation Emily can you talk about.

[Justin Chediak]

Infectious causes like pneumonia?

[Emily Eisenberg]

Definitely. Neonatal pneumonia can present at different times depending on whether it's congenital or acquired, and it's often hard to distinguish from sepsis because both can present with respiratory distress. Pneumonia accounts for about 5% of sepsis cases but carries a really high mortality for infants 35 weeks or greater. The early onset sepsis calculator helps guide labs and antibiotic use.

[Jake Anderson]

What are some less common causes of newborn respiratory distress?

[Emily Eisenberg]

So certain congenital conditions such as cardiac, diaphragm or other airway abnormalities can all really impact respiration and lead to distress. Metabolic causes, including hypoglycemia or other inborn errors of metabolism can also contribute, so knowing these prenatal risk factors really helps prepare for these scenarios.

[Justin Chediak]

While there's a lot that can go.

[Kari Staus]

Wrong, early recognition, stabilization and keeping a broad differential are going to be keys to optimizing outcomes for these newborns.

[Jake Anderson]

Moving right along, we have a practice guideline, 2025 recommended immunization schedule updated recommendations from the AAFB and it comes to us from Dr. Michelle Nelson from my Michigan Medical center in Midland, Michigan.

[Emily Eisenberg]

Certainly a hot topic right now. Historically, the AAFP has endorsed the immunization schedule published by the cdc, which is typically based on the recommendation of the Advisory Committee of immunization practices, the ACIP. However, the AAFP published its own 2025 recommendations with a few notable differences.

[Justin Chediak]

Dr. Nelson brings us a summary of those differences, as well as the updates since the 2024 CDC recommendations, which were endorsed by the AAFP.

[Jake Anderson]

All right, so first let's talk COVID vaccine.

[Emily Eisenberg]

So the AAFP aligns with the American Academy of Pediatrics and recommends universal vaccination for COVID 19 in children 6 to 23 months of age. The AAFP also recommends COVID 19 vaccination for those 2 to 18 years of age who are at high risk of severe COVID 19 or who may have household contacts at high risk of severe COVID 19.

[Kari Staus]

The AAFP also recommends COVID 19 vaccination for children age 2 to 18 years old who are residents of long term care facilities or have never been vaccinated against COVID 19. As far as which vaccine to use, the AFP recommends Moderna for those under age 5, Pfizer or Moderna for those age 5 to 11 and either of those or the Novavax for those 12 and older.

[Jake Anderson]

Yeah, so this is different from the CDC WHO recommends COVID 19 vaccination following a shared clinical decision making for children 6 months through 17 years who are not moderately or severely immunocompromised. As if we're ever doing this without shared decision making. Move on to Emily.

[Emily Eisenberg]

Definitely. The AAFP also recommends the COVID 19 vaccine during pregnancy and recommends universal vaccination for non pregnant adults.

[Jake Anderson]

So vaccination against COVID 19? Good idea. Next up, influenza. The AAFP recs are slightly different here, right?

[Kari Staus]

The big difference is that the CDC currently recommends using only single dose formulations of the seasonal flu vaccine, and that's.

[Jake Anderson]

Because those single dose vials are free of thimerosal, despite there being no evidence of harm related to this preservative that's used in multi dose vials. What are some of the other updates from the previous CDC recommendations?

[Emily Eisenberg]

Well, turns out pneumococcal vaccine also good. It's currently recommended as routine vaccination for all adults 50 years and older, a change from previously recommending 65 years and older.

[Justin Chediak]

The CDC approved use of the meningococcal.

[Kari Staus]

Groups A, B, C, W and y vaccine called PenMeNV, which combines two separate vaccines if both men ACWY and men B vaccination are indicated.

[Emily Eisenberg]

The CDC now recommends the Chikungunya vaccine in persons traveling to areas with a chikungunya outbreak, including Bangladesh, Kenya, Madagascar, Sri Lanka, Somalia, or for those traveling or living for six months or more in a country or territory with an elevated risk. And that includes Brazil, Colombia, India, Mexico, Nigeria, Pakistan, the Philippines and Thailand.

[Justin Chediak]

And for an ACIP update that has.

[Kari Staus]

Not yet been included in the CDC or AAFP immunization schedules, ACIP recommends Clesrovimab or Inflonzia a monoclonal antibody, as an alternative to nircivimab or Bay Fortis for infants younger than eight months entering their first RSV season who did not receive maternal protection through RSV vaccination.

[Emily Eisenberg]

And the ACIP has also expanded its recommendation for RSV vaccination to include those 50 to 59 years of age who are at increased risk of severe RSV disease.

[Jake Anderson]

More after this.

[Podcast Host/Announcer]

The AFP Podcast is sponsored by the American Academy of Family Physicians and by the journal fpm. FPM Journal provides you with simple yet powerful solutions to your everyday practice challenges. Available in print and online subscription information is [e-mail] fpm all right, we have.

[Jake Anderson]

A Cochrane For Clinicians Calcium Supplementation for Improving outcomes and it comes to us from doctors Devaraj and Gilbert from Penn State Health Milton S. Hershey Medical center in Hershey, Pennsylvania.

[Emily Eisenberg]

Okay, today we are looking at calcium supplementation in pregnancy, but instead of focusing on hypertensive disorders, we're focusing on other outco. Calcium is already recommended to reduce preeclampsia risk in patients with low dietary intake, but this review looks at whether it improves other maternal or infant outcomes.

[Justin Chediak]

So this Cochrane review included 19 randomized control trials with more than 16,000 pregnant.

[Kari Staus]

Patients across 13 countries. Patients with hypertension or multiple gestations were excluded. Trials compared calcium supplementation with placebo or no treatment. In most studies, high dose calcium, which was over 1,000 milligrams daily, was used. Baseline dietary calcium intake and labs were not clearly reported.

[Emily Eisenberg]

So it was found that calcium supplementation may slightly reduce late preterm birth between 34 and 37 weeks with a relative risk of 0.8 and that 95% confidence interval of 0.65 to 0.99. But absolute event rates were not reported. There was little to no effect on earlier preterm birth before 34 weeks for.

[Justin Chediak]

Low birth weight, which was defined as under 2,500 grams. Calcium supplementation overall showed little to no benefit. A small subgroup analysis suggested a possible reduction when calcium was started after 20 weeks with a relative risk of 0.41, but this was based on only three studies with 737 patients, making it difficult to generalize.

[Emily Eisenberg]

I think it's also important to note what calcium supplementation did not affect. The review found no evidence of benefit for maternal weight gain, bone mineral density, intrauterine growth restriction, perinatal mortality, or maternal death. There was also no increased risk of adverse effects such as gastrointestinal symptoms, kidney stones, UTIs, impaired renal function, or maternal anemia.

[Justin Chediak]

So what I'm hearing overall these findings don't substantially change our practice. Calcium supplementation is still best supported for preeclampsia prevention in patients with low dietary intake, as recommended by the WHO and acog.

[Emily Eisenberg]

Exactly. There may be small benefit in reducing late preterm birth, but overall effects are limited and more data is definitely needed to better define who benefits at what dose and when to start supplementation.

[Jake Anderson]

We have Another main topic, resistant hypertension in adults Evaluation and treatment. And it comes to us from physician, pharmacist, physician, team of doctors Haley Bragg and stem.

[Kari Staus]

Great.

[Justin Chediak]

I want to first define hypertension.

[Kari Staus]

The International Society of Hypertension guidelines have recommendations for blood pressure thresholds depending if it is in the office or at home. A diagnosis can be made when there are at least two measurements between one to four weeks with office readings of 14090 or greater, home readings of 13585 or greater or 24 hour ambulatory blood pressure readings of 130 over 80 or greater.

[Jake Anderson]

That's great. And what is resistant hypertension?

[Kari Staus]

Resistant hypertension will be defined as blood pressure above goal, which is generally over 140 over 90 for most patients, despite the use of maximum or optimal dosages of three antihypertensive agents and one must be a thiazide diuretic.

[Jake Anderson]

Got it.

[Emily Eisenberg]

It's extremely important that we appropriately evaluate resistant hypertension because not every patient that is on three antihypertensive agents and has blood pressure above 14090 truly has resistant hypertension. And Kari, tell us why.

[Kari Staus]

It seems basic, but we need to make sure patients have an accurate blood pressure reading. To get an accurate reading, we need to follow these guidelines. One, Use a properly fitting cuff on the bare mid arm at heart level. Keep the patient's feet uncrossed and flat on the floor. Keep the patient silent, which I'm guilty of not doing. Make sure the patient has rested three to five minutes prior to assessment. Make sure that the patient has abstained from caffeine, nicotine and exercise for 30 minutes and that the patient has an empty bladder.

[Emily Eisenberg]

Oh boy, that's quite the list. So let's say I have a patient we have established has resistant essential hypertension. What is my approach to optimize their regimen?

[Justin Chediak]

So my first intervention is always to identify lifestyle changes. And Table 3 in this article lists a lot of these interventions with their associated reductions in blood pressure. I want to draw attention to a few of these because these can be really motivating for patients.

[Kari Staus]

Appropriate physical activity can lower systolic blood pressure by 4 to 9 points. A DASH diet, which is dietary approach to stop hypertension, can reduce systolic blood pressure 8 to 14 points. And weight loss can reduce blood pressure up to a whopping 20 points per 10kg weight loss to a target of a normal BMI.

[Emily Eisenberg]

How's that?

[Jake Anderson]

Yeah, that's great. So we address lifestyle changes and we will want to confirm that the patient's on the Optimal first line antihypertensives, which include standard doses of dihydropyridine, calcium channel blockers like amlodipine, an ARB or ACE inhibitor, and a thiazide.

[Justin Chediak]

And just as a plug for starting multiple agents early, instead of maxing out on monotherapy, there is evidence that the addition of a second antihypertensive agent is five times more effective at lowering systolic blood pressure than doubling the dose of the original agent.

[Jake Anderson]

Yeah. Wow. That certainly solves the debate that we've had for many years. So let's reach for those combo drugs.

[Emily Eisenberg]

All right, our patient is on an optimal dose of calcium channel blocker, an angiotensin receptor blocker, and a thiazide. She's still uncontrolled. I usually start a mineralocorticoid receptor antagonist next. Is that consistent with the AFP recommendations?

[Justin Chediak]

Emily, it's like you read the article.

[Kari Staus]

It sure is.

[Jake Anderson]

So to summarize evaluation and treatment of resistant hypertension, we want to get an accurate blood pressure measurement. Of course. So make sure your patient doesn't have their coffee right before you measure their blood pressure. Use optimal blood pressure agents. Think calcium channel blocker, arb, ACE inhibitor, thiazide, diuretic at low standard doses in combination, instead of maxing out monotherapy doses. And if your patient's blood pressure is still above goal, the preferred fourth agent to start is a mineralocorticoid receptor antagonist. We're going to wrap things up with a poem, and this one comes to us from Dr. Mark A. Bell. DNA based blood tests for detecting colorectal cancer.

[Justin Chediak]

All right, we're talking about a new fancy DNA based blood test for colorectal cancer screening. Sounds exciting. Blood test instead of stool test or colonoscopy. But let's break down what the data actually shows.

[Emily Eisenberg]

So this study looked at over 27,000 average risk adults who had both the blood test and a colonoscopy. As colonoscopy again is our gold standard, the blood tested fairly well at finding established cancers, but it performed poorly at detecting advanced adenomas, which are precancerous polyps. That we definitely want to catch early.

[Jake Anderson]

Exactly. So the tests found about 80% of colorectal cancers overall in nearly all stage 2 to 4 cancers. But for advanced adenomas, the sensitivity was only 12.5%. That's much worse than a fit stool test, which is cheaper and better at catching these early warning lesions.

[Kari Staus]

And that's the problem. Right?

[Justin Chediak]

Screening is about preventing cancer, not just detecting it late. Because this blood test misses most advanced adenomas. It can give false reassurance and reduce the use of known screening tests such as FIT or colonoscopy that are proven to reduce mortality.

[Emily Eisenberg]

So bottom line, despite impressive numbers on paper, this blood test isn't ready to replace existing screening. For now, makefit or colonoscopy easy and stick with what we know. Definitely saves lives.

[Jake Anderson]

Send us your thoughts by emailing [e-mail].

[Kari Staus]

Follow on Instagram @afpjournal.

[Justin Chediak]

Please subscribe and rate us wherever you get your podcasts.

[Podcast Host/Announcer]

Escucha nos en espanol a revista medica a ffp.

[Jake Anderson]

Our podcast team is Jake Anderson, Puneet Bharot, Steve Brown, Justin Chediak, Sarah Coles.

[Steve Brown]

Austin Cotter, Rachel Dunn, Emily Eisenberg, Elena.

[Jake Anderson]

Kelly, Chisa Mokouagu, and Kari Staus.

[Kari Staus]

Our sound and technical guru is Tyler Coles. Our theme song is written and recorded by family physicians Bill Dabs, Ryan Evans, and Justin Jenkins.

[Podcast Host/Announcer]

This podcast is brought to you by the residents and faculty and of the University of Arizona College of Medicine, Phoenix Family Medicine Residency Programs.

[Jake Anderson]

We'll talk to you soon for the.

[Steve Brown]

Next edition of the American Family Physician Podcast.