Clinicians who weigh symptom control and biomarker response more heavily than quality of life risk overlooking the emotional and social toll of 

). Even when symptoms and biomarkers appear controlled, patients may still experience daily fear, activity avoidance, and social withdrawal.

In this Q&A, Thanai Pongdee, MD, of Mayo Clinic, discussed 

4-year data from the PIONEER trial showing that avapritinib continues to improve emotional well-being

 and social functioning in patients with ISM, extending beyond symptom and biomarker control alone.

The analysis, presented at the European Academy of Allergy & Clinical Immunology (EAACI) 2026 Annual Meeting in Istanbul, followed 226 patients treated with avapritinib 25 mg once daily, with a median treatment duration of 46.5 months.

Mean total symptom score on the ISM-Symptom Assessment Form and mean percentage change in the Mastocytosis Quality of Life Questionnaire total score both showed continued improvement from baseline through 1 and 4 years. Nearly half of patients reported less fear of an allergic reaction after long-term treatment, and by 3 years, 52% of patients had reduced or discontinued use of ≥ 1 class of best supportive care medication. The safety profile remained consistent through 4 years, with treatment-related discontinuations occurring in just 3% of patients and no new safety signals identified.

Avapritinib's 4-Year PIONEER Data Show Durable QoL Benefits in ISM

What does it mean to see clinically meaningful improvements in emotional well-being and social functioning, not just symptom or biomarker control, in this PIONEER analysis?

 It's very meaningful because not only do we want to see symptom improvement, but importantly we want patients to be able to function in their daily activities, whether it be work or social situations, because disease, being chronic in nature, can significantly impact those kinds of activities and emotional well-being, and create social isolation and negative feelings. Anything that can improve those aspects of a disease is as equally important as symptom control.

How do these emotional well-being findings, including reduced fear, loneliness, and sadness, compare with what you've observed in this patient population before treatment?

 The trial findings and report have certainly mirrored what we observe and hear from patients in the clinic, which is good to see. Many patients report being able to go out to eat with friends or family and not have to worry like they used to. They used to avoid going out to social functions because they were very worried about something happening or some symptom flare occurring.

After being on treatment, they've seen those symptoms improve or go away in many respects. They're able to engage in many activities that they otherwise would have avoided. In a similar way, on the work front, various work activities that may have been avoided or not even attempted may have limited their progress in the workplace. Having those restrictions or fears lessened or removed has certainly helped in that aspect as well.

How should this data change the way clinicians evaluate treatments and assess ISM beyond mast cell burden or serum tryptase?

 We always have to keep the patient at the center. It's nice to see biomarkers of disease improve, and that's obviously very important…but at the end of the day, the patients have to feel better, be able to function in an unrestricted manner. That's really the whole point of taking medicine, especially from a patient point of view.

Nearly half of patients reported less fear of an allergic reaction. How significant is anaphylaxis-related anxiety as a driver of quality of life in ISM, and how does avapritinib appear to address it?

 The fear of anaphylaxis or other allergic reactions significantly impacts the majority of patients with SM. There's this constant worry that this could happen at any time, and many of the medicines we have hopefully can reduce that risk of occurrence. It makes rational sense to think that if you're decreasing mast cell burden, the likelihood of such events would decrease.

Now, that wasn't a primary endpoint in the study. There was some retrospective evidence that avapritinib may help reduce risk of anaphylactic events. We published a short report to that effect, but that's still an open question, and it's being more thoroughly investigated in a current trial.

All I have to say is decreasing that risk and consequently the fear of that happening really frees patients to do activities that we would consider pretty typical that would have otherwise been avoided. Someone who never went out to eat, never went to a school reunion, never went to an employee picnic, things a lot of us take for granted, can [now] enjoy [these] activities.

Key Takeaway from This 4-Year Pioneer Analysis

What's the key takeaway for clinicians who currently weigh symptom control or biomarker response more heavily than quality of life measures?

 It's something you can't forget. All those aspects of treatment are very important, but we can't lose sight of quality of life.

How might these findings shape conversations with patients about what to expect when starting avapritinib?

 Patients want to know how they're going to feel. They want to understand what the drug is doing, and its mechanism of action.

At the end of the day, they want to know how it's going to make them feel better: “Is there a certain way it's going to help me feel better? Is it going to help my skin symptoms or my gastrointestinal symptoms, or should everything be better? Am I going to keep taking all the medicines I take now?”

Most patients have polypharmacy, and these things are all connected. If the disease burden is less, then I would expect symptoms to get better. Hopefully that means I don't have to [prescribe] as many medicines, and then all that equals greater quality of life.

What remains unknown about the durability of these emotional and social functioning benefits, and what follow-up data are you hoping to see?

 What was very encouraging in the data is that, at least at the 4-year cutoff, all aspects of improvement, whether it be symptoms, disease burden, or quality of life, are all durable improvements. Certainly, longer-term data is more encouraging and more reassuring, so keeping track of those features over time would be good to see.

Safety looked very good over the long term, with low incidence of any safety issues over 4 years. Patients always ask, "Well, how about in 5 years, 10 years, 15 years, if I keep taking this drug?" Seeing that long-term data will be very reassuring for everyone involved.

Watch parts 1 and 2 of the interview with Pongdee here: 

Avapritinib 4-Year PIONEER Data: Sustained QoL Gains in ISM

Avapritinib 4-Year Data Show Durable Quality of Life Gains in ISM

Pongdee T. Avapritinib 4-Year PIONEER Data: Sustained QoL Gains in ISM. HCPLive. Published July 13, 2026. Accessed July 27, 2026. 

https://www.hcplive.com/view/avapritinib-4-year-pioneer-data-ism-quality-of-life

Pongdee T. Avapritinib 4-Year Data Show Durable Quality of Life Gains in ISM. HCPLive. Published July 16, 2026. Accessed July 27, 2026. 

https://www.hcplive.com/view/avapritinib-4-year-pioneer-data-ism-pongdee

Broesby-Olsen S, Siebenhaar F, Oude Elberink H, et al. Mastocytosis Treated With Avapritinib: Updated 4-Year Results From The PIONEER Trial. Presented at European Academy of Allergy & Clinical Immunology (EAACI) 2026 Annual Meeting from June 12-15, 2026 in Istanbul, Türkiye.

Articles

Four-year follow-up of avapritinib in indolent systemic mastocytosis demonstrates sustained, clinically meaningful improvements in emotional well-being and social functioning alongside symptom and biomarker gains. Among 226 patients receiving avapritinib 25 mg once daily (median exposure 46.5 months), ISM-SAF total symptom scores and mastocytosis-specific QoL measures continued to improve through years 1 and 4. Nearly half reported reduced fear of allergic reactions, and by year 3, 52% decreased or stopped at least one supportive medication class. Safety remained consistent, with 3% treatment-related discontinuations.

Thanai Pongdee, MD, discusses how PIONEER data reveal quality of life gains that go beyond symptom and biomarker control in indolent systemic mastocytosis.

News

news page, resources on the topics of disease- and specialty-specific medical news and expert insight can be found. Content includes articles, interviews, videos, podcasts, and breaking news on health care research, treatment, and drug development.

Clinical

clinical page is a resource for content on every specialty, disease, and topic available on our medical news site.

Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

Walter J. Liszewski, MD, is an associate professor of dermatology and cancer epidemiology at Northwestern University Feinberg School of Medicine.

The rapid expansion of treatment options for 

 has transformed clinical decision-making, giving dermatologists more tools than ever to individualize care while introducing new questions about treatment selection, sequencing, and long-term disease management.

As biologics, Janus kinase (JAK) inhibitors, and advanced topical medications continue to reshape dermatology’s therapeutic landscape, clinicians are increasingly balancing efficacy, safety, patient preferences, and quality-of-life considerations when developing personalized treatment plans.

Revolutionizing Atopic Dermatitis (RAD) Conference

 in Nashville, Walter Liszewski, MD, an associate professor of dermatology and cancer epidemiology at Northwestern University Feinberg School of Medicine, highlights the evolving approach he explored in his session to selecting treatments for patients with atopic dermatitis.

In this Q&A interview, Liszewski shares his perspective on choosing between oral and biologic agents, the growing role of advanced topical drugs, managing patients after treatment failure, and how emerging biomarkers and long-term real-world evidence may help clinicians deliver increasingly personalized care in the years ahead:

 In your session at RAD, you focused on treatment selection across oral, biological, and topical options in atopic dermatitis. With more approved options in atopic dermatitis than ever before, has treatment selection gotten easier or more complex for the practicing dermatologist?

 It's gotten a little bit more complicated, only in the sense that we have more options available. This is a great thing for patients, because we have the ability to let patients control the conversation. Do they want an oral option? Do they want an injectable? What side effects are tolerable to them? How important is it to control how quickly it works?

Having more options available allows us to provide better care and allows patients to be more empowered. The other thing is that it gives us more options where things fail. That was part of one of my talks. Although we have great medications and have great therapies, not everyone responds, so having a backup plan or multiple backup plans is really helpful.

How do you think about the oral versus biologic decision in a field where the safety conversation around JAK inhibitors is continuing to evolve?

It's complicated. I do think that oral options like JAK inhibitors can be incredibly effective. However, the way that they're currently positioned, due to FDA labeling, is that they need to be used when a patient is found to have a systemic agent. So, are there patients who would benefit from starting with a JAK inhibitor as their first advanced agent? Absolutely, but unfortunately, that's not something we can do. We do have more and more safety data about JAK inhibitors. I think there's really starting to be a turn within the dermatology practice. I think many providers are starting to feel more comfortable using JAK inhibitors. I think we're going to see more momentum, more utilization in the coming years.

The emergence of advanced topicals has expanded the toolkit. Should dermatologists be incorporating them rather than defaulting to what they already know?

Using advanced therapies can be very effective, and it's important to remember atopic dermatitis exists across the spectrum of mild, moderate, and severe, and sometimes those are fluid in patients. We do know that atopic dermatitis is a long-term chronic condition. For some patients, short-term use of topical steroids can be effective, particularly if their disease doesn't flare. That often tends to be very mild, but for some patients who have more chronic disease that don't necessarily qualify or need a biologic, that's where these advanced therapies are great.

But what's really exciting is we know even when we use advanced therapies, our oral agents or biologics, not everyone gets completely clear. We can still have hotspots that are active areas that are very bothersome, either cosmetically or in terms of itching patients. That's where we can leverage and utilize advanced therapies that have safer long-term utilization in combination with advanced therapies. It is really the next step in managing atopic dermatitis.

Sequencing after treatment failure is one of the murkier areas in atopic dermatitis management. How do you approach that decision, and what does the evidence actually support?

 Yeah, this is kind of the wild west. So, we have case reports, and we have individual experiences. For me, if someone's failed a biologic in a JAK, and this is what I talked about in my presentation, it's really challenging because we don't really have a backup option right now. We do have things in the pipeline that potentially, in the next 1 or 2 years, may give us a different mechanism of action. Things like the OX-40s. Currently, though, we have a variety of options. One is to utilize a biologic or JAK inhibitor in combination with phototherapy.

It's a little bit of an insurance nightmare, but using a biologic with a JAK inhibitor, and there is some evidence for escalating JAK inhibitors above the standard atopic doses, particularly for drugs like upadacitinib, which do have higher 45 milligram dosing. There is evidence for using those for long-term or short-term control in patients who fail current FDA-approved concentrations for atopic dermatitis.

 How much patient preference and quality of life priorities? Let's say. Driving treatment selection, and is the field doing enough to sort of center that? Would you say in clinical decision making?

 I haven't been in practice that long. I've only been in practice now for about 8 years, but not that long ago, when I was in residency, we never really talked about itch in atopic dermatitis. Since then, there's really been a major change in conversation with our patients who are asking about itch and how they feel. I think we've really seen a major shift in terms of how we're incorporating patient symptoms and how we can control the RPs.

I think we're going to continue to see more utilization not only about asking but also sometimes for using patient-reported outcome measures. Things like a POM score or just routinely asking about NRS-Itch or NRS-Sleep can really help us better understand the symptoms our patients are going through and whether or not our patients are being fully controlled. Not only in terms of skin clearance, but also in terms of symptoms such as itch or pain or insomnia or anxiety.

Looking at where the evidence gaps still are, what would you say is most helping practicing dermatologists make more confident, individualized decisions for their atopic dermatitis patients?

I think that because we have more therapies, we're starting to see more data, and also just real-world use of trying different drugs, which patient populations do well with one but not another. I think we're still figuring that out. We are starting to see the beginnings of utilization of biomarkers commercially to identify and segment patients. I think there's going to continue to be refinement and improvement in that, and I think when that is at a very high level, highly successful, then hopefully we'll have an ability to routinely personalize medications based on a patient's genetic need. Excellent,

How do you think the treatment selection conversation will change as long-term real-world data continues to mature?

 I think it's going to, in many ways, maybe make it a little bit more difficult because as we have more data, there's more we need to review, and for patients, there's a lot they have to digest. So having more data is a good thing. It helps us know long-term what the safety maturity is. What is this long-term X? Is it durable? So having more data that shows that these drugs are effective long-term, that there's continued improvement over time, is helpful. It's also very reassuring.

The more extension trial safety data we have, because these medications are long-term medications. So knowing what the long-term side effects are. On the flip side, it's a lot more that we have to review with our patients. But ultimately, the more data we have, the more we can empower our patients to make the decision that's right for them.

Disclosures: Liszewski did not have any relevant disclosures of note.

Liszewski W, Rubin C, Cotter D, et al. Session 4: Medical Crossfire® and Clinical Case Challenge. Session presented at: 2026 Revolutionizing Atopic Dermatitis Conference; June 17-19, 2026; Nashville, TN.

The proliferating atopic dermatitis armamentarium is increasing decision complexity while enabling more patient-driven, individualized care. Selection now hinges on route of administration, speed of onset, tolerability, and contingency planning for nonresponse. Oral JAK inhibitors offer high efficacy, but FDA positioning and evolving safety perceptions influence sequencing and uptake. Advanced topical agents are increasingly used both for chronic moderate disease not warranting systemic therapy and as adjuncts for residual “hotspots” on systemic treatment. Evidence gaps persist post-failure; biomarkers and maturing real-world datasets may refine personalization.

Walter Liszewski, MD, discusses how dermatologists can personalize atopic dermatitis treatment using biologics, JAK inhibitors, and topicals.

Atopic Dermatitis

Atopic Dermatitis condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatitis research, treatment, and drug development.

Dermatology

The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

Q&A: How Is Treatment Selection Changing in Atopic Dermatitis?

Alex Hillenbrand is an assistant editor for 

. She earned her BA in English from Lafayette College in 2023 and went on to write for pop culture, entertainment, and sports media outlets before joining MJH Life Sciences in 2025. In her free time, Alex enjoys cooking, going on walks, and meeting new people. Contact her at mjhlifesciences.com.

The US Food and Drug Administration (FDA) has approved Freenome's SimpleScreen™ CRC, a blood-based colorectal cancer (CRC) screening test for adults aged ≥45 years who are at average risk for the disease, providing clinicians with a second FDA-approved blood-based screening option for eligible patients.

The approval was supported by findings from the PREEMPT CRC study, the largest prospective clinical validation study conducted for a blood-based colorectal cancer screening test. SimpleScreen CRC detects cell-free DNA (cfDNA) signals associated with colorectal cancer from a blood sample and is intended for screening asymptomatic adults at average risk.

Colorectal cancer remains the second-leading cause of cancer-related death in the United States despite being highly preventable through routine screening. According to Freenome, up to 60 million Americans remain overdue for recommended screening, highlighting the need for additional screening options that may improve participation among eligible adults.

"The most effective screening test is the one a person will actually complete," said Aasma Shaukat, MD, MPH, professor of medicine at NYU Grossman School of Medicine and co-lead principal investigator of the PREEMPT CRC study. "Many people who should be screened for colorectal cancer simply aren't. A blood-based test provides another way to reach unscreened patients, and bringing more people into the screening fold leads to earlier detection and better outcomes."

FDA approval was based on results from PREEMPT CRC, a prospective clinical validation study conducted at more than 200 sites that enrolled more than 48,000 asymptomatic adults aged 45-85 years at average risk for colorectal cancer who were scheduled to undergo screening colonoscopy.

In a prespecified analysis adjusted to reflect the US Census population, SimpleScreen CRC demonstrated:

 for advanced precancerous lesions (APLs)

According to the company, the findings indicate the blood test correctly detected approximately 8 in 10 colorectal cancers while correctly producing negative results for about 9 in 10 individuals without colorectal cancer or advanced precancerous lesions.

SimpleScreen CRC becomes the second FDA-approved blood-based screening test for colorectal cancer in average-risk adults. The approval expands the range of noninvasive screening options available to clinicians alongside stool-based testing, colonoscopy, CT colonography, and flexible sigmoidoscopy.

As with other noninvasive colorectal cancer screening tests, a positive SimpleScreen CRC result should be followed by diagnostic colonoscopy. The test is intended for adults aged ≥45 years who are at average risk for colorectal cancer and is not a replacement for diagnostic colonoscopy or surveillance colonoscopy in high-risk individuals.

Freenome stated the FDA approval meets Medicare coverage criteria for the test and said it expects SimpleScreen CRC to be incorporated into future American Cancer Society screening guidance by name, which could further expand access to blood-based colorectal cancer screening for eligible adults. Abbott plans to exclusively commercialize the test in the United States beginning this fall.

Shaukat A, Burke CA, Chan AT, et al. Clinical validation of a circulating tumor DNA-based blood test to screen for colorectal cancer. 

 2025;334(1):56-63. doi:10.1001/jama.2025.7515.

US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. 

 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238.

FDA approves Freenome's SimpleScreen CRC blood test for colorectal cancer screening in average-risk adults aged ≥45 years.

Gastroenterology

Gastroenterology condition center page is a comprehensive resource for clinical news and insights on digestive and GI conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for 

, IBS and IBD, Crohn's disease, and more.

FDA News

FDA Approves Freenome Blood Test for Colorectal Cancer Screening

Saakshi Khattri, MD, is a board certified Dermatologist, Rheumatologist and Internist and one of only a handful of triple board-certified physicians across the US.

Most psoriatic arthritis is preceded by psoriasis, which puts dermatologists on the front line of early detection. The panel details which patients warrant a closer look and how to screen efficiently.

Screening Psoriasis Patients for Early Psoriatic Arthritis

This episode, "Screening Psoriasis Patients for Early Psoriatic Arthritis," turns to what a dermatologist should ask and look for when psoriasis walks through the door.

Dr. Wright starts with location, since most psoriatic arthritis is preceded by psoriasis. Where psoriasis sits changes the risk, so scalp involvement and skin folds raise concern. She then asks the simpler question: is the patient in front of her reporting joint pain or morning stiffness? She points to the PEST questionnaire, which patients can complete in the waiting room in seconds. A positive score should trigger a referral to someone who can manage it.

Dr. Wright acknowledges the flip side, which is access to rheumatology. Care deserts in rural and under-resourced areas can mean a 9-to-14-month wait, which is not early by any definition. She also raises skin of color, warning that clinicians trained only on lighter skin tones miss psoriasis entirely, so patients arrive already mislabeled with something else.

Dr. Han reviews the risk factors that have held up. Higher body surface area, roughly 75% or more or three distinct anatomical areas, is the most consistent signal. Obesity and nail psoriasis also track with psoriatic arthritis, with nail disease supported by the anatomical link between nail and joint. He is more skeptical of scalp psoriasis, since it is so prevalent, up to 80% in some ethnic groups, that it barely discriminates. He treats the severe, obese patient with nail disease as the clearest alarm bell.

Dr. Han endorses the PEST as a tool that actually saves time, sparing dermatologists the rabbit hole of open-ended joint questioning. Dr. Wright adds that a young patient whose joints have aged beyond their years should be an immediate red flag worth interrogating rather than accepting at face value.

"Breaking Down Silos: Rheum-Derm Collaboration in Psoriasis Care,"

 the panel steps back to ask how rheumatologists and dermatologists can actually work together, from combined clinics to simply picking up the phone.Welcome back to another HCPLive Peer Exchange series. In "Where Psoriasis and PsA Care Stand Today: Burden and Unmet Needs," moderator Saakshi Khattri, MD, FACR, FAAD is joined by George Han, MD, PhD and Grace Wright, MD, PhD, FACR to open the series on psoriatic disease.

Videos

Video Series

Abbas Zaidi, MD, is an assistant professor at Thomas Jefferson University and the medical director of outpatient cardiology at Nemours Children’s Health.

Abbas Zaidi, MD | Image Credit: Nemours Children's Health

A recent study from Nemours Children’s Health has highlighted many of the common barriers to pediatric 

 screening, suggesting a series of actionable strategies for improvement.

The study took the form of semi-structured, qualitative interviews conducted with 25 clinicians across 10 pediatric primary clinics. The interviews aimed to identify barriers to hypertension detection from the perspective of clinicians actively attempting to diagnose the condition.

Among the survey responses, 5 major themes were identified – these included a lack of standardized clinical pathways, inadequate training and confidence, EMR design and workflow misalignment, a lack of equipment availability and maintenance, and inefficient communication and referral pathways. The surveys also produced 5 recommendations to improve these issues – these were the implementation of a standardized clinical pathway for blood pressure measurement, competency-based training and educational resources, optimization of EMR integration, ensuring readily available and well-maintained equipment, and strengthening communication between primary care physicians and communications, respectively.

Abbas Zaidi, MD, assistant professor at Thomas Jefferson University, medical director of outpatient cardiology at Nemours Children’s Health, and lead investigator of the study, spoke with 

 in an exclusive interview to discuss the ideal structure for pediatric hypertension diagnosis and treatment, as well as how clinicians can achieve this goal.


Why is pediatric hypertension still missed?

HCPLive: Pediatric hypertension guidelines have been available for years, yet detection rates remain low. Why has this remained such a persistent problem despite increasing awareness?

That's a great question. So, as you can imagine, we work in pretty complex healthcare ecosystems. As you try to bring change or improve care, what I've realized through years of studying this is that it's a system of interconnected challenges that have to work together. And when one part of that system breaks down, the whole pathway fails, and it becomes really complex, especially when you think about how complex the guidelines are.

For pediatric patients, you have to look at their age, gender, and height specific percentiles to even detect high blood pressure. The measurement itself can be quite demanding; the child has to sit still for 5 minutes, with both feet on the ground, and you have to pick the correct cuff size. And if you do all of those things perfectly, then you have to ask the families to come back for multiple visits to get to a diagnosis, and you need at least three to make a diagnosis for hypertension. This means that the families now are facing real-world challenges that intersect with the healthcare system challenges that we're facing.

Families lose income every time they have to take time off to come to clinic. Kids have to miss school. Insurance doesn't always cover visits, and it can be a challenge. It's not just one thing that makes hypertension detection fail. It's a very complex conglomerate of factors that are intersecting with a complex guideline. And on the health system side of things, if you think about it, there's no clear clinic workflow or EMR-based tools. And if there is no sort of alert system telling physicians exactly what they need to do as next steps, and that leads to this black box of care. So, it's not about awareness or not knowing that the guidelines exist or not knowing that this is a problem in kids. It's not a failure at any one point. It's a failure at multiple points in this complex system.

HCPLive: The study suggests that even motivated clinicians can miss hypertension because of workflow issues. Which step in the diagnostic process is most vulnerable to failure in routine pediatric practice?

There have been studies on this, and even within our preliminary data that we had, we know that majority of pediatric patients who are coming for volunteer child visits are getting a blood pressure check. It's not that people aren't getting a blood pressure check - 97% of kids get a blood pressure checked in clinic. It's actually the step immediately after they get the blood pressure check, which is where their vulnerability really starts in my mind. Even if it's recorded correctly in the chart, if nothing is flagging it appropriately, or there's no automated trigger or a protocol that starts the chain of events that the physicians need to do to start a conversation with the family about, “Hey, you need to come back,” then that's where the problem starts.

Even if physicians do recognize that it's abnormal, and they tell the family to come back for a repeat measurement, what happens next remains a black box. Once families leave the clinic, they're operating in an environment where we obviously don't have control, and we're intersecting with a lot of social determinants of health factors such as losing money, taking time off, leaving school, and all of that. These are not small inconveniences. If you think about it, they're directly impacting families and their lives. So, in my mind, the critical point is after the initial blood pressure gets measured and what happens next.

HCPLive: Many clinicians assume time pressure is the primary obstacle, but the study suggests inefficient systems may be a bigger issue. How should practices rethink their workflows to improve diagnosis without asking clinicians to do more?

I think what I really wanted to highlight in this study is that it's a health system problem. Our findings definitely are pushing back on that assumption that a simple fix is telling physicians what to do or telling them to slow down or double check more. Clinicians are already stretched thin, and asking for more vigilance without changing the system is just going to add more friction, and that's going to erode over time. We see that play out in healthcare systems every day.

I think the more sustainable approach is to build that recognition as part of the workflow and support physicians who are already busy. These clinicians also have to navigate not just hypertension guidelines, but a lot of other pediatric-related care in 15-minute clinic visits. So having the right decision support that, for example, automatically flags an abnormal blood pressure and spits out exactly what they need to do next, and for them to easily sign off on that to do their part. The goal isn't to make sure they're putting in more effort. It's to have fewer touch points where the system is going to fall apart, and for everything to be more automated.


What does the study believe should be improved, and how can clinicians approach doing so?

Abbas Zaidi, MD: The clinicians interviewed repeatedly called for simplified clinical pathways instead of expecting providers to navigate lengthy guidelines during a busy clinic session. What would an ideal decision-support pathway actually look like in practice?

We're in the process of developing our own pathway, and I know there's been work nationally and at different various institutions in developing pathways. I think in my mind, an ideal pathway would initially surface an alert when the reading is actually abnormal and is appropriately flagged. So that's the first step to making sure that the blood pressure reading itself is being picked up as abnormal using guideline-appropriate data, and then using that to tell physicians in plain language that “hey, you need to repeat this.” For the front-line staff, one thing we learned in our study is that the guidelines need to be tailored to the end user - they can't just be one guideline that applies to different roles within the healthcare system. You need role-specific pathways and guidelines where the MAs get an alert about repeating the blood pressure and how exactly they need to do that, versus a physician getting all of that data to make that clinical decision, integrating the patient's blood pressures, labs, and other testing in one visual of what those trends look like over time to make that clinical decision. Ideally, they’ll then, with a click of a button, move the patient along in that pathway to the next step. I think they need to be seamless. They need to be role specific, and they need to integrate patient data in a more seamless way for physicians to make decisions quickly.

HCPLive: Looking beyond pediatric hypertension, could these implementation barriers be representative of broader challenges in preventive cardiovascular care? What lessons could adult cardiology or other specialties take from these findings?

I think this basically represents that science to practice gap, and this is a known phenomenon: it takes about almost two decades for evidence-based practice to get into clinical care, and only a fraction of that actually reaches a patient. What we're unfolding here – or rather, scratching the surface on - is a very complex, larger health system issue, which also, of course, intersects with what happens in adult cardiology. If you take the analogy of hypertension and apply that across preventive cardiovascular care for adults, you can start to see similar patterns of treating detection failures as knowledge or motivation problems. We've been saying, “let's respond to this with more education” when the failure actually is very structural. It's a health system issue, and one purpose for me in doing the study and highlighting these findings is for them to be more generalizable across various healthcare systems, including adult cardiology, because they have their own version of very similar problems. I think the lesson that can transfer over is that closing a gap usually isn't about convincing clinicians to do more. It's about identifying the specific steps in the workflow, and for health systems to really invest in that effort, to then make sure that the systems aren't silently dropping the signals that are clearly there but are working to redesign and make health systems better around the steps, rather than just asking clinicians to work with more diligence.

Editors’ Note: Zaidi reports no relevant disclosures.

Nemours Children’s Health. Nemours Children’s Health Study Identifies Strategies to Improve Pediatric Hypertension Screening Rates. July 14, 2026. Accessed July 24, 2026. 

https://nemours.mediaroom.com/PediatricHypertensionScreeningStudyZaidi

Zaidi AH, Sood E, De Ferranti S, et al. Clinician Perceptions of Barriers and Strategies to Improve Pediatric Hypertension Detection. 

Nemours Children’s Health qualitative interviews with 25 clinicians across 10 pediatric primary care clinics identified multifactorial, system-level causes of pediatric hypertension under-detection despite high BP measurement rates. The most failure-prone point occurs after an elevated reading, when inadequate EMR flagging, absent standardized pathways, and poor role delineation prevent timely repeats and follow-up. Additional barriers include limited training confidence, equipment gaps, and inefficient referral communication, compounded by family-level burdens of repeat visits. Proposed solutions emphasize standardized, role-specific decision support, EMR optimization, reliable equipment, and streamlined communication pathways.

Abbas Zaidi, MD, discusses his recent study providing 5 pain points and 5 suggested improvements for the pediatric hypertension treatment flow.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Hypertension

The HCPLive hypertension page is a resource for medical news and expert insights on high blood pressure. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for hypertension, and more.

Q&A: How to Optimize Pediatric Hypertension Diagnosis and Treatment

Plaque psoriasis has reached total clearance for many patients, yet psoriatic arthritis still lags behind. The panel opens by mapping where the two halves of psoriatic disease diverge.

Where Psoriasis and PsA Care Stand Today: Burden and Unmet Needs

Alex Hajduczok, MD, is an advanced heart failure and pulmonary hypertension specialist at Oklahoma Heart Institute. 

The latest episode of Moving the Needle in Medicine features Philip Adamson, MD, MSc, as he discusses ongoing changes in the way heart failure is treated and prevented.

Heart Failure

The HCPLive heart failure page is a resource for medical news and expert insights on HF. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for heart disease, reduced and preserved ejection fraction, and more.

Rethinking Advanced Heart Failure: Treat the Disease, Not the Symptoms

Ramy Hanna, MD, discusses early IgAN recognition, biopsy decisions, and how emerging therapies are reshaping disease management.


Nephrology

The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

IgA Nephropathy

The HCPLive Berger disease page is a resource for medical news and expert insights on IgA nephropathy. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in Berger disease, and more.

Early Detection and Treatment Advances in IgA Nephropathy, With Ramy Hanna, MD

University of Colorado Health Sciences Center

Daniel Soteres, MD, discusses KONFIDENT-S data showing sebetralstat improved quality of life for HAE patients already stable on long-term prophylaxis.

Sebetralstat Shows QoL Gains on Top of HAE Prophylaxis in KONFIDENT-S

Stay updated with the latest healthcare breakthroughs, including phase 3 plozasiran data in hypertriglyceridemia, the FDA approval of Furoscix ReadyFlow, and more.

Hematology

The HCPFive: Top News for Healthcare Providers from the Week of 07/19

The latest episode of Moving the Needle in Medicine features Philip Adamson, MD, MSc, as he discusses upcoming advancements in heart failure care.

Can We Stop Heart Failure at Its Source?

The latest episode of Moving the Needle in Medicine features Philip Adamson, MD, MSc, as he walks through his long and successful career in cardiology.

Lessons From a Career Dedicated to Transforming Heart Failure Care

Daniel Soteres, MD, discusses KONFIDENT-S data showing sebetralstat quickly resolves breakthrough HAE attacks in patients on long-term prophylaxis

Sebetralstat Resolves Breakthrough HAE Attacks Despite Prior Prophylaxis

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for 

. He is also the executive producer of two podcasts: 

. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

Sanofi has discontinued development of OX40L-targeting amlitelimab for atopic dermatitis, following the heels of Kyowa Kirin's similar rocatinlimab discontinuation.

Sanofi Announces Discontinuation of Amlitelimab for Atopic Dermatitis

Mandana Khalili, MD, is Chief of Clinical Hepatology and Director of Clinical and Translational Research in Hepatology at San Francisco General Hospital, and directs the UCSF T32 Hepatology Training Program.

Telehealth stepped alcohol treatment reduced weekly drinking, but not the primary endpoint, among patients with chronic liver disease.

Hepatology

MASH / MASLD

The HCPLive MASH & MASLD page is a comprehensive resource for clinical news and insights on metabolic dysfunction-associated steatotic liver disease and steatohepatitis. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for fatty liver disease, steatohepatitis, and more.

Latest News

Avapritinib's 4-Year PIONEER Data Show Durable QoL Benefits in ISM

Q&A: How Is Treatment Selection Changing in Atopic Dermatitis?

FDA Approves Freenome Blood Test for Colorectal Cancer Screening

Screening Psoriasis Patients for Early Psoriatic Arthritis

Q&A: How to Optimize Pediatric Hypertension Diagnosis and Treatment