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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and\nTreatment of High Blood Pressure (JNC-7) offered evidence-based approaches for the prevention and\nmanagement of hypertension (HTN). But debate continues about optimum strategies as HTN continues to\nbe redefined. Highlights from a plenary session look at two key concerns.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ehypertensive\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EControversies in the Management of Hypertension\u003C\/h2\u003E\n         \u003Cp id=\u0022p-2\u0022\u003EThe Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and\nTreatment of High Blood Pressure (JNC-7) offered evidence-based approaches for the prevention and\nmanagement of hypertension (HTN). But debate continues about optimum strategies as HTN continues to\nbe redefined. Highlights from a plenary session look at two key concerns.\u003C\/p\u003E\n         \u003Cdiv id=\u0022sec-2\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EImplications of the JNC 7 BP Category \u201cPrehypertension.\u201d\u003C\/h3\u003E\n            \u003Cp id=\u0022p-3\u0022\u003EOnly 30% of Americans have blood pressures less than 140\/90, which led to the creation of\na new JNC 7 category\u2014prehypertension\u2014defined as SBP between 120\u2013139 and DBP of\n80\u201389.\u003C\/p\u003E\n            \u003Cp id=\u0022p-4\u0022\u003E\u201cIs drug therapy an appropriate option for prehypertension?\u201d asked William\nC. Cushman, MD, University of Tennessee School of Medicine at Memphis. Dr. Cushman reviewed findings\nfrom the HOT Study, which showed benefit in lowering DBP to 82.6 mm\/Hg. Other clinical trials also\nsuggest that \u201clower is better.\u201d\u003C\/p\u003E\n            \u003Cp id=\u0022p-5\u0022\u003EJNC 7 describes prehypertension as a \u201cdesignation \u2026 to identify individuals at high\nrisk of developing hypertension, so that both patients and clinicians are encouraged to\nintervene.\u201d\u003C\/p\u003E\n            \u003Cp id=\u0022p-6\u0022\u003EPrehypertension is \u201cnot an indication for treatment, per se,\u201d said Dr. Cushman.\n\u201cAt least not yet. But it does carry significant predictive value for development of\nhypertension and CV events.\u201d\u003C\/p\u003E\n            \u003Cp id=\u0022p-7\u0022\u003E\n               \u003Cstrong\u003EHypertension in the Elderly.\u003C\/strong\u003E Should we be aggressive in treating hypertensive\npatients older than 80 years? \u201cYes\u2014but with caveats,\u201d said Marvin Moser,\nMD, Yale University School of Medicine, New Haven, CT.\u003C\/p\u003E\n            \u003Cp id=\u0022p-8\u0022\u003E\u201cHypertension starts higher and goes higher in elders,\u201d Dr. Moser said. \u201cBut\nthis doesn\u0027t mean we should aggressively treat hypertension in each and every elderly\npatient.\u201d\u003C\/p\u003E\n            \u003Cp id=\u0022p-9\u0022\u003EDr. Moser noted this patient population is variable in general health and almost always presents\nin a context of comorbidities\u2014as well as a range of capacities in daily living.\u003C\/p\u003E\n            \u003Cp id=\u0022p-10\u0022\u003E\u201cDrug treatment is only part of the picture,\u201d Dr. Moser said, advising less\nemphasis on mortality and morbidity and more on quality of life. \u201cStress lifestyle changes.\nStart with a low-dose diuretic. Add an ACEI, ARB, CCB, or beta blocker if you need to. But if your\npatient complains about side effects, stop, look, and listen. Don\u0027t just insist they stay on\nthe medicine. When managing the elderly, look at the whole picture.\u201d\u003C\/p\u003E\n         \u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ELVH Regression in Hypertension: Emerging Issues\u003C\/h2\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThe LIFE study offered compelling evidence that LVH regression is associated with improved\ncardiovascular outcomes. Is LVH regression an independent marker in the management of hypertension\nor other coronary syndromes? Seminar highlights look at two critical perspectives.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003E\n            \u003Cstrong\u003ELVH Regression to Stratify Risk.\u003C\/strong\u003E Kristian Wachtell, MD, PhD, of the Copenhagen\nCounty University Hospital in Gostrup, Denmark, said \u201cwe should measure LV structure and\nfunction to stratify risk.\u201d Dr. Wachtell reviewed data from the LIFE study, where patients\nwith moderate hypertension and LVH were randomized to receive losartan versus atenolol. Both LVH and\nLV mass index decreased throughout the study, reductions \u201cstrongly linked to reduced CV\nmorbidity and mortality, independent of randomization, the severity of baseline LVH, or baseline and\non-treatment BP,\u201d according to Dr. Wachtell. \u201cThese data tell us that LVH regression\nindependently predicts improved outcomes.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003E\n            \u003Cstrong\u003EDoes Lowered BP Drive LVH Regression?\u003C\/strong\u003E \u201cIs it simply lowering BP that\nleads to LVH regression, or is the relationship drug-dependent?\u201d asked Bjorn Dahlof,\nMD, PhD, of the Sahlgrenska University Hospital in Goteborg, Sweden. \u201cIn some studies a\ngreater reduction in LV mass was seen in one or the other treatment arm. So we might conclude the\neffect is specific to the drug used.\u201d But Dr. Dahlof cautioned that studies to date use\nintermittent office-based brachial BP readings, \u201cwhich correlate less with LVM as compared to\nambulatory blood pressure monitoring.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EThe LIFE study \u201coffered breakthrough insights,\u201d Dr. Dahlof said, notably that\n\u201cLVH and LV mass reduction are associated with improved outcomes for all CV endpoints. But\nLIFE did what every good study does: calls for further research to address new questions.\u201d\nFor example, \u201calthough losartan performed better than atenolol, more than half of LIFE\nparticipants were on at least one additional antihypertensive. Was LVH regression linked to losartan\nalone? Or will a combination of agents offer a better result? We look forward to\nresearch to come.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECAFE Study: Blood Pressure Varies Based on Where and How It\u0027s Measured\u003C\/h2\u003E\n         \u003Cp id=\u0022p-15\u0022\u003E\u201cGetting a blood pressure check\u201d has always meant inflating a cuff on the arm just\nabove the elbow and measuring the fall in pressure at the brachial artery. A new study suggests\nthat\u0027s only one window on blood pressure\u2014and not always the best one.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EAntihypertensive drugs that reflect lowered pressures when measured in the arm appear to have\ndifferent effects on the circulation near the heart, according to Bryan Williams, MD, professor of\nmedicine in the department of cardiovascular sciences at the University of Leicester, UK, and\nprincipal investigator for the Differential Impact \u2014 Principal Results of the Conduit Artery\nFunction Evaluation (CAFE) Study, a sub-study of 2,199 people from the nearly 20,000-person\nAnglo-Scandinavian Cardiac Outcomes Trial (ASCOT).\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EASCOT, one of the largest studies of hypertension ever conducted in Europe, assessed amlodipine\nplus perindopril against atenolol and a thiazide diuretic. The amlodipine\/perindopril arm\ndemonstrated significantly better CV endpoints. CAFE participants were recruited from among ASCOT\nparticipants.\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EIn CAFE, investigators used a software application that measures central aortic systolic blood\npressure based on reading the radial pulse wave contour. This information is then computed to\nextrapolate central pulse pressure measurements in the large arteries of the body. \u201cThe CAFE\nStudy indicates that the shape of the pulse wave is influenced by the treatments we use to lower\nblood pressure,\u201d said Dr. Williams. \u201cTreatment with amlodipine had more favorable\neffects on the pulse wave and pressures in the main arteries than did treatment based on\natenolol.\u201d\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/20\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-335623087\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/20\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/20\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/20\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16077\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EOf note is that the brachial arm blood pressure readings were essentially the same whether the\nantihypertensive agent used was the calcium channel antagonist or beta-blocker.\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EIn finding that amlodipine reduced central aortic pressure by 4.3 mm Hg as compared with\natenolol, CAFE may take a step further in explaining differences seen in ASCOT\u2014where\namlodipine plus perindopril demonstrated greater efficacy in reducing both BP and CV events.\u003C\/p\u003E\n         \u003Cp id=\u0022p-21\u0022\u003EA further implication of this observation is that brachial blood pressure measurement\nunderestimated the effectiveness of amlodipine in comparison to atenolol\u2014a fact that could\nmislead clinicians who must make treatment decisions.\u003C\/p\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EIn CAFE, researchers noted that while brachial blood pressures were essentially equal in the\ntreatment groups, there were reductions in average central aortic pressure values favoring\namlodipine. \u201cThe assumption has been that all types of blood pressure treatments are equally\neffective. We show that this is untrue,\u201d Dr. Williams said.\u003C\/p\u003E\n         \u003Cp id=\u0022p-23\u0022\u003EDr. Williams reported that \u201cCAFE demonstrates for the first time in a large clinical\noutcomes trial that blood pressure-lowering drugs have profoundly different effects on central\naortic pressures and hemodynamics, despite a similar impact on brachial blood pressure. The results\nof this study are clear-cut, dramatic and potentially very important. It also may explain why\ncertain types of hypertension treatment might be more effective than others.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2005 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/5\/1\/20.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm322\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm322\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}