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Hypertension in the 21st Century was chaired by Dr Paola Santalucia and Dr Alastair Webb, in a very well attended and interactive session, despite being the last session of the conference. The audience heard 4 excellent talks on the current approach to hypertension in patients at significant risk of stroke, from current guidelines to new approaches to monitoring and treating hypertension.

The talks began with a tour of the current European Society of Hypertension hypertension guidance from Professor Sverre, Norway, interpreted in the context of patients with stroke, but concentrating primarily on the evidence for current primary prevention strategies, with a particular focus on the advantages of angiotensin receptor blockers. This view from a past president of ESH provided a different but extremely valuable perspective compared to those of us steeped in the specifics of secondary stroke prevention.

This was followed by a detailed discussion of the challenges and benefits of accurately identifying patients with hypertension through alternative monitoring strategies from Professor Jonathan Mant, Professor of Primary Care, University of Cambridge. The advantages of ambulatory blood pressure monitoring over clinic measures, and the potential of home blood pressure monitoring for identification of hypertension and improvement of concordance to optimise blood pressure control was made clear, with these important new approaches likely to take a central role in our future management of this most important of risk factors for stroke.

Professor Oscar Benavente, Professor of Neurology, Vancouver, and principal investigator of the seminal SPS3 study discussed the optimal target for control of blood pressure in patients with stroke. Specifically, in discussing ‘how low should we go,’ he demonstrated both the lack of current evidence in stroke populations, the potential to improve outcomes by more aggressive blood pressure control and the potential risks and challenges in such an approach that are yet to be resolved.

Finally, the session was closed by Dr Alastair Webb from the Centre for Prevention of Stroke and Dementia, University of Oxford, with a discussion of the epidemiological evidence and likely physiological basis for the relationship between variability in blood pressure and an increased risk of stroke and other cardiovascular events. This exciting new topic in hypertension management, particularly for stroke prevention, is still a challenging risk factor for practising clinicians to measure, treat and interpret.

Overall the session was an excellent balance of current clinical applications, novel methods and research targets, building the understanding of attendees to guide their current and future practice.

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