Highlights From the ISH/ESH Hypertension Meeting In Berlin 
Peter M Nilsson， Malm??， Lund University， Sweden

In Berlin several new findings were presented. An update on clinical trials was given. In the ONTARGET trial similar clinical effects were seen in hypertensive risk patients receiving either telmisartan，and angiotensin-2 recpetor blocker， or ramipril， and ACE-inhibitor. This means that for cost-effectiveness most patients in need of ACE-inhibition could benefit from starting with ramipril， butif this combination is associated with side effects， the choice of telmisartan could be one valuablealternative. Further data from ONTARGET on renal outcomes and reduction of proteinuria are still eagerly awaited.

The treatment of elderly subjects has been elucidated in the recent HYVET trial were benefits for prevention of mortality， fatal stroke and congestive heart failure has been proven in patients 80 years and above given either perindopril and indapamide (an ACE-inhibitor and a modern diuretic) or placebo. Finally， in the ACCOMPLISH trial a 20% risk reduction for cardiovascular end-points was noticed for the combination of benazepril and amlopidin versius the combination of benazepril and a thiazide diuretic. As 60% of the patients included in ACCOMPLISH had type 2 diabetes， this means that the first combination should often be preferred in this group of patients at increased risk.

In the genetic area of research it was shown during last year that several major disorders could be mapped based on whole genome scan analyses (WGSA)， for example type 2 diabetes and coronary heart disease. Hypertension， however， has so far not been possible to map， and that could be due to the fact that poorly characterised normotensive controls have been used， many of them having elevated blood pressure (miss-classification). Therefore researchers in Scotland (Anna Dominizcak) and Sweden (Olle Melander) have joined forces to try to compare patients with established hypertension with°∞hypernormal°± normotensive controls， with repeated blood pressure recordings within the normal range and with no family history of hypertension or related cardiovascular events.Results will hopefully be ready for presentation in 2009.

Finally， much focus in Berlin was also put on the emerging research filed of measuring and understanding the role of arterial stiffness， a marker of risk and vascular ageing. Especially Stephan Laurent， Paris， has contributed much to the understanding of arterial stiffness when the measurement of pulse wave velocity (PWV) is considered as the°∞golden standard°± methodology. It has been shown that subjects with increased PWV (> 12m/s) run a considerably increased risk and that blood pressure control and multiple risk factor reduction is mandatory to prevent complications. So far the measurement of PWV and the related pulse wave analysis (PWA) has been technically difficult， but new devices are being invented for continuous measurement during 24 hours of PWA by a wrist device. I am sure that more will be learnt about this and presented at future meetings.