Calcium channel blockers are a favorable choice for monotherapy and in combination with other agent classes AZD6244 nmr in many patients, and may provide benefits over other classes for certain CV outcomes Out-of-office BP measurements provide more comprehensive information to inform accurate diagnoses of hypertensive conditions, and are more prognostic

of patient outcome than office measurements. Ambulatory and home BP monitoring are likely to play an increasing role in hypertension management in the future, although their value for patient evaluation and appropriate treatment selection should be more widely acknowledged 1 Introduction The European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) guidelines for the management of arterial hypertension were updated in 2013,

implementing a number of changes since the previous 2007 version [1, 2]. A key amendment for 2013 was the recommendation for more simplified blood pressure (BP) targets across groups of patients with hypertension, with all subjects to be treated to systolic BP (SBP) of <140 mmHg (apart from elderly patients) and to diastolic BP (DBP) of <90 mmHg (apart from those with diabetes mellitus) [2]. Further updates in the ESH/ESC guidelines include: more specific lifestyle recommendations, such as limiting salt intake to 5–6 g/day and lowering body mass index to 25 kg/m2; more balanced discussion on the advantages and disadvantages of initiating monotherapy versus combination therapy; recommendation against dual renin-angiotensin system buy Tucidinostat (RAS) blockade (owing to concerns about renal damage and increased incidence of stroke); reconfirmation of the importance of ambulatory BP monitoring (ABPM) and strengthened endorsement of the prognostic value of home BP monitoring (HBPM) for the diagnosis of isolated office (‘white coat’) and isolated ambulatory (‘masked’) hypertension [2]. With regard to the choice of antihypertensive agent, the 2013 ESH/ESC guidelines reconfirm that a diuretic, Tangeritin β-blocker, calcium channel blocker (CCB), angiotensin II

receptor blocker (ARB), and angiotensin-converting enzyme (ACE) inhibitor are all suitable for use as monotherapy, and in some combinations with each other [2]. Of these agents, β-blockers appear to be losing favor as recommended initial monotherapy in other recent guidelines [3, 4], and the combination of an ARB and an ACE inhibitor is no MK-8931 ic50 longer endorsed [2–4]. Dihydropyridine CCBs have no compelling contraindications for use and are a preferred drug in many combination strategies [2], making them a favorable choice for many hypertensive patients. Indeed, CCBs have been cleared of the suspicion of increasing the incidence of coronary events [2, 5]; and these agents may even be slightly more effective than other agents in preventing stroke [6–8]. In the light of the ESH/ESC guidelines update, we wished to take a fresh look at this established class of antihypertensive agent.