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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\u003EWhile the 2013 Joint National Committee Guidelines for the Management of High Blood Pressure in adults still under revision and not available for discussion, this article discusses new and important recommendations from the Canadian Hypertension Education Program [Daskalopoulou SS et al. \u003Cem\u003ECan J Cardiol\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\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 \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EWith the 2013 Joint National Committee Guidelines for the Management of High Blood Pressure (BP) in adults still under revision and not available for discussion, Suzanne Oparil, MD, University of Alabama at Birmingham, Birmingham, Alabama, USA, discussed new and important recommendations from the Canadian Hypertension Education Program (CHEP) [Daskalopoulou SS et al. \u003Cem\u003ECan J Cardiol\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn the last few years, out-of-office (home) BP measurement has assumed a more prominent role in the diagnosis and follow-up of hypertensive patients, in part because it may help to identify \u201cwhite coat\u201d or \u201cmasked\u201d hypertension. Differentiation is important because those with masked hypertension have a higher rate of cardiovascular events compared with patients who are normotensive or have white coat hypertension. Previously, patients who were found to have normal BP at home (ie, \u0026lt;135\/85 mm Hg) but elevated readings in the office were recommended for 24-hour ambulatory monitoring to confirm white coat hypertension. The Task Force has now added repeat home BP monitoring as another method to confirm white coat hypertension in such patients.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe Task Force also made an important modification to the management recommendations for patients with hypertension associated with nondiabetic chronic kidney disease. After a comprehensive reassessment of the evidence examining BP targets in this patient population, it concluded that there was insufficient evidence to support a target of 130\/80 mm Hg. Therefore, the target BP in this patient population was changed to \u0026lt;140\/90 mm Hg, similar to the general population.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe summary of evidence from CHEP for patients with diabetes and hypertension suggest lowering systolic BP to \u0026lt;140 mm Hg to reduce all-cause mortality and stroke, with systolic BPs \u0026lt;135\u2013130 mm Hg appearing to confer significant additional benefits with respect to stroke. Although the risk of serious adverse events increases with BPs \u0026lt;140 mm Hg, the absolute number of these risk events is low, and therefore, the \u0026lt;130\/80 mm Hg BP target in patients with diabetes remained unchanged in the current CHEP recommendations.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EMonotherapy is often not enough [Cushman WC et al. \u003Cem\u003EJ Clin Hypertens (Greenwich)\u003C\/em\u003E 2002], especially for patients with diabetes, and therefore, many hypertensive patients now receive \u22652 antihypertensive agents. According to the Task Force, using single pill combinations may help to achieve BP control by improving medication compliance. Another way to improve patient compliance with BP treatment is to start an ongoing counseling to discuss and assess coronary risk (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Grover SA et al. \u003Cem\u003EJ Gen Intern Med\u003C\/em\u003E 2009].\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\/2\/11\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Impact of Discussing Coronary Risk With Hypertensive Patients\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1380237160\u0022 data-figure-caption=\u0022Impact of Discussing Coronary Risk With Hypertensive Patients\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\/2\/11\/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\/2\/11\/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\/2\/11\/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\/13110\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\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EImpact of Discussing Coronary Risk With Hypertensive Patients\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EThe American Diabetes Association\u0027s (ADA) 2013 edition of Standards of Medical Care in Diabetes recommends that individuals with diabetes and hypertension be treated to a systolic BP goal of \u0026lt;140 mm Hg consistent with the CHEP guidelines [ADA \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2013]. In contrast, however, they note that some lower targets for specific patients and for diastolic BP including a systolic BP target of \u0026lt;130 mm Hg may for certain individuals (eg, younger patients) if it can be achieved without unnecessary treatment burden and target diastolic BP for diabetic patients of \u0026lt;80 mm Hg. Patients with BP \u0026gt;120\/80 mm Hg should be persuaded to make lifestyle changes, while those with BP \u2265140\/80 mm Hg should begin treatment with \u22651 pharmacological agents (either an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker) plus lifestyle therapy to achieve BP goals. Finally, for pregnant patient with diabetes and chronic hypertension, the ADA suggests BP target goals of 110\/65 to 129\/79 mm Hg in the interest of long-term maternal health and to minimize impaired fetal growth.\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\/2\/11.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?nzo09p\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?nzo09p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}