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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.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\u003EGuidelines for the management of hypertension (HT), aiming at providing the most balanced recommendations that are supported by evidence-based approaches, are currently in place and focus on mean blood pressure (BP) values. However, questions have been raised as to whether or not other models or algorithms are more suitable for HT assessment and treatment. This article discusses the issue of BP variability and guidelines from a practical perspective.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EGuidelines for the management of hypertension (HT), aiming at providing the most balanced recommendations that are supported by evidence-based approaches, are currently in place and focus on mean blood pressure (BP) values. However, questions have been raised as to whether or not other models or algorithms are more suitable for HT assessment and treatment. Anthony M. Heagerty, MD, University of Manchester, Manchester, UK, discussed the issue of BP variability and guidelines from a practical perspective.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EESH\/ESC 2007 guidelines recommend a variety of treatment approaches, depending upon mean BP (ranging from normal to high normal and Grades 1 through 3 HT) and the type and number of other risk factors that are present [ESH\/ESC Task Force on the Management of Arterial Hypertension. \u003Cem\u003EJ Hypertens\u003C\/em\u003E 2007]. According to a study by Rothwell and colleagues, visit-to-visit variability in sytolic BP and maximum systolic BP is a strong predictor of stroke and other cardiovascular (CV) events, independent of mean BP. Additionally, this variability accounted for a difference in treatment effect that was observed in two large trials (UKTIA and ASCOT) [Rothwell PM et al. \u003Cem\u003ELancet\u003C\/em\u003E 2010]. This stroke risk may be reduced with a reduction in visit-to-visit BP variability by initiating calcium channel blocker and diuretic therapy. \u03b2-blocker therapy appeared to be the least effective for the reduction of visit-to-visit variability and associated stroke risk (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Rothwell PM et al. \u003Cem\u003ELancet Neurology\u003C\/em\u003E 2010].\u003C\/p\u003E\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\/10\/5\/17\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Role of Increase in Central Aortic and Pulse Pressure in the Increase of CV Events.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-855340009\u0022 data-figure-caption=\u0022Role of Increase in Central Aortic and Pulse Pressure in the Increase of CV Events.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/5\/17\/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\/10\/5\/17\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\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\/10\/5\/17\/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\/11317\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\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003ERole of Increase in Central Aortic and Pulse Pressure in the Increase of CV Events.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from A. Heagerty, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EThese new data regarding BP variability provide useful information about risk assessment and may be helpful when considering treatment strategies in the future. However, more research is needed to determine the clinical utility of this measurement. Assessment of BP variability is required in everyday practice, but quantifying such instability in this setting poses a challenge. While we now know that stable BP is better than episodic HT, a clinically translatable test that utilizes these data has yet to be developed. Additionally, treatment algorithms should confirm a downgrade of \u03b2-blockers and calcium channel blockers as first-line therapy for all age groups.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EProf. Heagerty explained the role of visit-to-visit BP variability in guideline improvement and treatment optimization. Ambulatory BP monitoring may be too narrow a focus and may not identify those at highest risk. Emphasis should be on consistency of BP control and stabilization in order to properly assess risk and manage HT. The incorporation of visit-to-visit variability into treatment guidelines will provide more accurate risk prediction and will broaden the focus of new drug development to include BP-stabilizing medications, which may be better suited to prevent stroke than currently recommended approaches.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThough current guidelines are useful for determining an appropriate treatment strategy for a variety of hypertensive patients, there appear to be gaps in these recommendations that are related to BP variability and associated risk. Further prognostic studies are warranted before BP variability can be incorporated into guidelines and clinical practice. A quantitative assessment algorithm is also needed to ensure that the BP variability treatment approaches are reliable and accurate for future widespread use. Recent data regarding this aspect of HT are promising, but it would be premature to alter strategies at this time, based on the limited available data.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 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\/10\/5\/17.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?nzmr4q\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?nzmr4q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}