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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\u003EThe 2013 European Society of Hypertension (ESH)\/ European Society of Cardiology (ESC) guidelines for the management of hypertension have recently been released [Mancia G et al. \u003Cem\u003EBlood Press\u003C\/em\u003E 2013; \u003Cem\u003EEur Heart J\u003C\/em\u003E 2013; \u003Cem\u003EJ Hypertens\u003C\/em\u003E 2013]. This article provides an overview of these 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\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EExclusive Article - For home page\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe 2013 European Society of Hypertension (ESH)\/European Society of Cardiology (ESC) guidelines for the management of hypertension have recently been released [Mancia G et al. \u003Cem\u003EBlood Press\u003C\/em\u003E 2013; \u003Cem\u003EEur Heart J\u003C\/em\u003E 2013; \u003Cem\u003EJ Hypertens\u003C\/em\u003E 2013]. Josep Redon, MD, PhD, Hospital Clinico, University of Valencia, Valencia, Spain, gave an overview of these guidelines.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPrevious versions of the guidelines were issued in 2003 [ESH\u2013ESC Guidelines Committee. \u003Cem\u003EJ Hypertens\u003C\/em\u003E 2003] and 2007 [Mancia G et al. \u003Cem\u003EJ Hypertens\u003C\/em\u003E 2007], and a reappraisal of the guidelines was issued by the ESH in 2009 [Mancia G et al. \u003Cem\u003EJ Hypertens\u003C\/em\u003E 2009]. Prof. Redon said that for the development of the 2013 guidelines, over an 18-month period, task force members sought to revise previous recommendations where necessary and provide recommendations based on appropriately conducted studies selected from a thorough review of the literature. Data from randomized trials and their meta-analyses were given the highest priority, but results from observational and other studies of appropriate scientific caliber were also considered, especially those with a diagnostic focus. In addition to internal reviewers, the content was reviewed twice by a panel of 40 European experts. For the first time, evidence and recommendations were also graded (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\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\/13436\/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\/13436\/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\/13436\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-4\u0022 class=\u0022first-child\u0022\u003EEvidence Grade and Definitions\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EThe 2013 guidelines include sections on epidemiological aspects, diagnostic evaluation, treatment approaches and strategies, treatment of associated risk factors, follow-up, improvement of blood pressure (BP) control in hypertension, hypertension disease management, and gaps in evidence and need for future trials.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ERobert H. Fagard, MD, PhD, Katholieke Universiteit Leuven, Leuven, Belgium, provided a summary of the 2013 ESH\/ESC guideline recommendations regarding diagnosis and lifestyle changes in patients with hypertension. To put the guidelines in perspective, Dr. Fagard gave a brief overview of the epidemiology of hypertension in Europe. The prevalence of hypertension in Europe is approximately 30% to 45% [Pereira M et al. \u003Cem\u003EJ Hypertens\u003C\/em\u003E 2009]. There are notable differences in the average BP levels across countries, making it difficult to compare results among countries and longitudinally, said Prof. Fagard. For this reason, it has been suggested that stroke mortality be used as a surrogate marker of hypertension status [Cooper RS. \u003Cem\u003EHypertension\u003C\/em\u003E 2007]. Based on statistics from the World Health Organization, stroke mortality has decreased in western European countries but increased in eastern European countries [Redon J et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EPer the 2013 ESH\/ESC guidelines, total cardiovascular (CV) risk stratification using the Systemic Coronary Risk Evaluation (SCORE) model is strongly recommended as a minimal requirement for asymptomatic hypertensive patients with no evidence of CV disease, chronic kidney disease, or diabetes. Furthermore, clinicians are advised to look for evidence of organ damage, especially in patients with moderate risk, as there is evidence that asymptomatic organ damage predicts CV death independently of SCORE. Treatment strategies should be based on the initial level of total CV risk. While total CV risk stratification is traditionally based on BP readings taken in the office, the new guideline has a provision for considering out-of-office BP in the risk stratification model to elucidate which patients may have white-coat (or isolated office) hypertension or masked (isolated ambulatory) hypertension.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe initial assessment of patients with hypertension should confirm the diagnosis of hypertension, detect causes of secondary hypertension, and evaluate CV risk factors, asymptomatic organ damage, and concomitant medical conditions. Prof. Fagard reviewed the best practices for BP measurement. BP should preferably be measured at the upper arm, with the cuff adjusted to arm circumference. After the patient has sat for 3 to 5 minutes, \u22652 BP measurements should be taken 1 to 2 minutes apart. Additional measurements should be obtained if the first 2 are very different. Heart rate should be determined after the second BP reading. In cases where orthostatic hypotension is suspected, such as in the elderly and patients with diabetes, BP should be measured 1 and 3 minutes after standing.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EPatients diagnosed with hypertension can benefit from lifestyle modifications (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E). In addition to lowering BP, lifestyle changes help control other CV risk factors and medical conditions.\u003C\/p\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\/13438\/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\/13438\/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\/13438\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-10\u0022 class=\u0022first-child\u0022\u003ERecommendations on Lifestyle Changes\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-14\u0022\u003EGiusseppe Mancia, MD, Centro di Fisiologia Clinica e Ipertensione, Milan, Italy, reviewed drug treatment recommendations from the 2013 ESH\/ESC guidelines.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EBased on available evidence, recommended target BP is a systolic BP \u0026lt;140 mm Hg and a diastolic BP \u0026lt;90 mm Hg, regardless of risk. Additionally, task force members decided not to rank antihypertensive drugs for the following reasons: the primary mechanism associated with the benefit of antihypertensive treatment is the lowering of BP per se; the effects on cause-specific outcomes are very similar between drugs; patient outcomes are unpredictable; and each drug class has its advantages and disadvantages. Instead, the task force has provided recommendations based on trial data in specific conditions to help clinicians select the most appropriate drug, taking into account risk factors and adverse events.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EIn terms of combination therapy, it remains true that most patients require \u22652 drugs to control BP. Combination therapy is best for patients with high baseline BP or with high risk, and in all cases, moving from a less intensive therapy to a more intensive strategy should be undertaken if the target BP is not met. A schematic of mono versus combination therapy strategies is illustrated in \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E.\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\/13\/9\/4\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Mono Versus Combination Therapy to Achieve Target Blood Pressure\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-563513573\u0022 data-figure-caption=\u0022Mono Versus Combination Therapy to Achieve Target Blood Pressure\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\/13\/9\/4\/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\/13\/9\/4\/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\/13\/9\/4\/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\/13434\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-17\u0022 class=\u0022first-child\u0022\u003EMono Versus Combination Therapy to Achieve Target Blood Pressure\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EBP=blood pressure; CV=cardiovascular.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-18\u0022\u003EIn his closing remarks, Prof. Mancia encouraged clinicians to read the section on \u201cgaps in evidence and the need for future trials\u201d that is listed in the guidelines and emphasized the need for more research in the area of hypertension.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 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\/13\/9\/4.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?nznu0p\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?nznu0p\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?nznu0p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}