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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\u003EFor most clinicians, one of the most anticipated guideline updates is the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8). The JNC 8 has been in development for some time and is expected to be released by the end of 2012. This article provids an update on the process and timing for these eagerly awaited guidelines.\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\u003EFor most clinicians, one of the most anticipated guideline updates is the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8). The JNC 8 has been in development for some time and is expected to be released by the end of 2012. Suzanne Oparil, MD, University of Alabama, Birmingham, Alabama, USA, provided an update on the process and timing for these eagerly awaited guidelines.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EA fundamental change, and part of the reason for the delay in issuing the guidelines, noted Dr. Oparil, is the adoption of a rigorous nine\u2013step systematic review and development process (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Previous versions of the guidelines have received criticism for relying too heavily on low\u2013level evidence and consensus [Tricoci P et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2009], and this new, more rigorous approach will result in guidelines that are strictly evidence\u2013based. The recommendations will draw from the results of randomized controlled trials (RCTs) that assess important health outcomes rather than intermediate or surrogate endpoints. The new approach also involves an expanded group of experts on the guideline committee, which now includes expertise in hypertension, primary care, cardiology, nephrology, clinical trials, research methodology, evidence\u2013based medicine, epidemiology, guideline development and implementation, nutrition\/lifestyle, nursing, pharmacology, systems of care, and informatics. Senior scientists from the National Heart, Lung, and Blood Institute (NHBLI) and National Institute of Diabetes and Digestive and Kidney Diseases have also joined the panel as nonvoting members.\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\/12\/4\/8\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022NHBLI Systematic Review and Guideline Development Process.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1721086734\u0022 data-figure-caption=\u0022NHBLI Systematic Review and Guideline Development Process.\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\/12\/4\/8\/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\/12\/4\/8\/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\/12\/4\/8\/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\/14014\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\u003ENHBLI Systematic Review and Guideline Development Process.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from S. Oparil, 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\u003EThe JNC 8 is expected to focus on three major areas: the threshold blood pressure (BP) for drug therapy initiation, the target BP for drug therapy, and the most appropriate drugs to achieve the target BP. Prespecified subgroups of interest include patients with diabetes, chronic kidney disease (CKD), coronary artery disease, peripheral artery disease, or heart failure (HF); older patients; men and women; and racial and ethnic groups. Outcomes will focus on overall, cardiovascular (CV), and CKD mortality, myocardial infarction, HF, hospitalization for HF and stroke, coronary and peripheral revascularization, and end\u2013stage renal disease.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EUsing the JNC 7 as a backdrop, Kenneth A. Jamerson, MD, University of Michigan, Ann Arbor, Michigan, USA, discussed the initial choice of therapy for hypertensive patients who are at low and high risk for CV events. In general, Dr. Jamerson stressed the importance of combination therapy, noting that nearly all monotherapy trials for BP control were \u201cin essence combination therapy trials anyway\u201d (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). As an example of risk\u2013stratified recommendations, he reviewed the 2010 Updated Consensus on the Management of Blood Pressure in Blacks, issued by the International Society for Hypertension in Blacks [Flack JM et al. \u003Cem\u003EHypertension\u003C\/em\u003E 2010]. For primary prevention in low\u2013risk patients with BP \u2265135\/85 mm Hg but without target\u2013organ damage or overt or preclinical cardiovascular disease (CVD), this consensus document recommends a modest lowering of target BP to \u0026lt;135\/85 mm Hg using lifestyle modification and drug therapy. For patients in this group whose BP is consistently \u0026lt;145\/90 mm Hg, the recommendations encourage the use of comprehensive lifestyle modification for up to 3 months without concurrent drug therapy. For high\u2013risk patients with BP \u2265130\/80 mm Hg and target\u2013organ damage, preclinical CVD, or the presence or history of CVD, these consensus guidelines recommend a lower BP target of \u0026lt;130\/80 mm Hg using both lifestyle modification and drug therapy. As to the choice of drug therapy, Dr. Jamerson sees no advantage to using diuretics as initial therapy, suggesting that both high\u2013 and low\u2013risk patients benefit more from combination therapy (preferably with an ACE inhibitor and amlodipine), as it provides prompt and efficient BP control. Given the importance and proven efficacy of lifestyle modification in reducing BP, Dr. Jamerson suggested an article by Scisney\u2013Matlock M. et al. in \u003Cem\u003EPostgrad Med\u003C\/em\u003E 2009 as a good resource for those who are interested in strategies to overcome the barriers to patient compliance.\u003C\/p\u003E\u003Cdiv id=\u0022F2\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\/12\/4\/8\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Multiple Medications Are Required to Achieve BP Control in Clinical Trials.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1721086734\u0022 data-figure-caption=\u0022Multiple Medications Are Required to Achieve BP Control in Clinical Trials.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/4\/8\/F2.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\/12\/4\/8\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\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\/12\/4\/8\/F2.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\/14015\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 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EMultiple Medications Are Required to Achieve BP Control in Clinical Trials.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from WC Cushman, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003ECurrent target BP guidelines are not drawn from RCTs; rather, they are based on a general acceptance of the concept that \u201clower is better,\u201d particularly so for patients who are at higher risk. One of the major unknowns with the JNC 8 is whether there will be changes to BP targets. William C. Cushman, MD, Veterans Affairs Medical Center and University of Tennessee College of Medicine, Memphis, Tennessee, USA, discussed why he believes that there are good reasons for the guidelines not to go below BPs that have been proven in RCTs, although he emphasized that this was his opinion and not to be assumed what JNC 8 will recommend. These include:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \u003Cp id=\u0022p-9\u0022\u003EA much larger proportion of the population of the United States will be classified as having hypertension that presumably needs drug therapy [Greenlund KJ et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2004]\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n            \u003Cp id=\u0022p-10\u0022\u003EPatients who were previously classified as having hypertension will require more drugs to achieve lower BP goals [Cushman WC et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2010]\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n            \u003Cp id=\u0022p-11\u0022\u003ETreating to lower BP targets at a population level may be harmful, in that some patients may achieve BP levels that are too low (a concept known as the J\u2013curve) [Messerli FH et. al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E 2006]\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n            \u003Cp id=\u0022p-12\u0022\u003EIf neither beneficial nor harmful, resources would be wasted and, importantly, patient adherence may suffer\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-13\u0022\u003E\u201cIf we are to use RCTs to set BP targets, what is the evidence?\u201d asked Dr. Cushman. For diastolic targets, he noted that several trials have demonstrated a consistent reduction in CV events using a diastolic goal \u0026lt;90 mm Hg. Examples includes the landmark VA Cooperative Morbidity Trial in Hypertension [Veterans Administration Cooperative Study Group on Antihypertensive Agents. \u003Cem\u003EJAMA\u003C\/em\u003E 1967 and 1970] and the Hypertension Detection and Follow\u2013up Program [HDFP Cooperative Group. \u003Cem\u003EJAMA\u003C\/em\u003E 1979]. At least one trial, the Hypertension Optimal Treatment (HOT) study [Hansson L et al. \u003Cem\u003ELancet\u003C\/em\u003E 1998], did ask the question \u201cIs lower better?\u201d for diastolic BP, noted Dr. Cushman, and the results showed that for most patients, there is neither benefit nor harm with going below a diastolic BP of 90 mm Hg. As for systolic targets, there is good RCT evidence for a systolic BP target of \u0026lt;150 mm Hg (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E), but there is no strong support from RCTs for a target of 140 mm Hg or lower (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14016\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14016\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14016\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\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003ESystolic BP trials Testing SBP Goals and Showing CVD Benefit.\u003Csup\u003E1\u003C\/sup\u003E\n            \u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14017\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14017\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14017\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\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003ETrials Testing Systolic BP Goal \u0026lt;140 mm Hg.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-18\u0022\u003ERCT data support BP goals of \u0026lt;150\/90 mm Hg in most hypertensive patients; however, a goal of \u0026lt;140\/90 mm Hg may still be reasonable, especially for patients aged under 60 years or with CKD. In hypertensive patients with diabetes, RCTs support BP goals of 140\u2013150\/80\u201385 mm Hg or lower. The ACCORD BP Trial did not prove CVD benefit for a systolic goal \u0026lt;120 mm Hg compared with a goal of \u0026lt;140 mm Hg [Cushman WC et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2010]. SPRINT and several other trials are testing lower BP goals that may provide more clarity regarding optimal BP targets. Regardless of the results, these important studies of lower BP targets will need to be incorporated into future guidelines.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\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\/12\/4\/8.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?nzngtq\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?nzngtq\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_tables.js?nzngtq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}