The traditional way to evaluate blood pressure is by office recordings, either supine or sitting, but in more recent years home blood pressure measurements and 24-h ambulatory blood pressure recordings (24-h ABPM) have become more widely used. One newer aspect is to measure arterial stiffness by pulse wave velocity (PWV), as an indication of the target organ damage caused by elevated blood pressure. In more recent years researchers have started to analyse also other aspects of blood pressure regulation, such as blood pressure variability that can be calculated as the standard deviation of the mean of repeated recordings over a certain time period. This was recently high-lighted in a series of papers that appeared in the Lancet 2010 by Rothwell and colleagues [1-3]. They described an increased cardiovascular risk associated with increased visit to visit blood pressure variability in hypertensive patients.  An interesting finding is that antihypertensive drugs may interfere with this phenomenon differently. It appears at present that this is different from increased blood pressure variation in normotensive subjects that may be a normal physiological variation in relation to circulatory demands on haemodynamic function. 

In our view these new findings based on intervention studies, are very interesting and should be further investigated. At this time it is, however, difficult to translate these findings into the clinical consultation with an individual patient and focus should remain achieving targets recommended in guidelines. Ideally, intervention trials should be designed to treat hypertensive patients with randomised drug therapy based on the degree of blood pressure variability at baseline. At the ESH XX Meeting in Oslo 18-21 June 2010, these findings will be further discussed in a plenary session on Sunday afternoon 20^th June.

Besides that many interesting new data from observational as well as interventional studies will also be presented in the hot-line sessions. A few examples include among others: "Blood pressure reduction in 15,000 outpatients with hypertension in real life. Results of the 3A Registry" (Saturday 19^th), "Inflammatory marker in prehypertension are associated with body mass but not with blood pressure trends" (Sunday 20^th), and "Heterogeneity in discontinuation of antihypertensive treatment between drugs from the same class" (Monday 21^st).

The advances in genetics of hypertension and cardiovascular disease will be discussed at a morning breakfast session on Sunday 20^th June 2010. There are hopes for the future that this line of research will ultimately provide new understanding of regulatory mechanisms and new drug targets to be explored. The potential is considerable for personalised medicine based upon the new genetic discoveries and systems medicine to bring forward new antihypertensives to address unmet need in cardiovascular disease prevention. 

Peter M Nilsson                                              Mark Caulfield
Professor, web-editor                                    Professor, web-editor
Malmo, Sweden                                              London, UK

References 

1. Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B, Sever PS, Poulter NR. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 13;375:895-905.

2. Webb AJ, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. Lancet 2010;375:906-15.

3. Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet 2010;375:938-48.