Istituto Auxologico Italiano and Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università di Milano, Milan, Italy
Correspondence to Alberto Zanchetti, Università di Milano, Milan, Italy. Tel: +39 02 50320484; fax: +39 02 50320480; e-mail: email@example.com
Received 17 October, 2012
Accepted 17 October, 2012
A few weeks ago, when reading an obituary of Arthur Ochs Sulzberger, who was, for many years, publisher and chairman of The New York Times, I was impressed by a statement he made in an interview years ago: ‘There's no shortage of news in this world, he said. You’re not buying news when you buy The New York Times. You are buying judgement’.
I feel these wise words apply to scientific journals as well. There is no shortage of scientific news in our world, if a journal like the Journal of Hypertension – one of the 15 journals in this speciality area listed in Current Contents – can only publish one of every four papers being submitted. Judgement from which this selection depends is primarily exercised by expert reviewers, who scrutinize the originality of the approach, the correctness of the methodology, and the value of the results (i.e. the news), and often help the authors to improve the quality and the interest of their presentation. Then the editors’ judgement is exerting an arbitration role between reviewers’ opinions and, again to use Mr Sulzberger's words, adjudicates and sets standards.
The journal judgement is, by its nature, hidden behind the news, and readers take advantage of that judgement remaining largely unaware of it. To paraphrase the late Mr Sulzberger, they buy the judgment without being able to appreciate the judgement process and therefore to take sides on the opinions upon which this process is founded. Through the years of our editorship, we have tried to bring judgment as much as possible to the surface. Since 2002, we have published editorial commentaries, commonly prepared by reviewers or editors, on selected papers, in order to place them in the context of current knowledge and of a critical evaluation. This has been appreciated by readers and fellow scientists, and these commentaries often receive a number of citations (and occasionally more than the accompanying original paper). It has apparently been appreciated by editors of other journals in the hypertension area as some of these journals have subsequently followed this initiative. This flatters our pride.
Last year we tried to go further in making reviewers’ judgement more manifest, by asking them to express in a short paragraph strengths and limitations of the accepted papers, to be published at the end of each paper. We know this is a further demanding task to be added to the time they are volunteering for the journal, but we are confident reviewers will be rewarded by the increased appreciation of fellow scientists for the judgement they contribute. We are also aware not all authors may appreciate having the limitations of their study being explicitly mentioned at the end of their paper, but they will understand that in this way some of their contributions, judged of potential interest but not without limitation, may achieve publication, which may not occur without making these limitations explicit. Whenever an author may feel to have been unfairly treated in one of these summary comments, the correspondence section of the journal is open to appeals. The authors’ judgement is thus given voice apart from the reviewers’.
During 2013, we are planning to go further in making judgement more and more apparent in the Journal of Hypertension. Papers being published in each single issue are the emerging tip of a much larger number of manuscripts being submitted, and represent a kind of temporary summa of what best has been submitted and produced in hospitals and laboratories, according to peer reviewers’ and editors’ judgement. At a time when reading of articles is increasingly being done by crossing keywords on Pubmed or similar repertories, and is being done out of the context of other articles in the same area (hypertension, cardiovascular and renal regulation, cardiovascular prevention in the case of the Journal of Hypertension), the editor is planning a short monthly commentary to uncover the thread of judgment leading each month to select and publish a number of articles on various aspects of hypertension research, thus giving a temporary picture of how and where research is moving. A first attempt to summarize the major aspects of research results in the January issue follows.
The majority of papers published this month focus on a few recurrent issues of hypertension research. The first is that of the relation between high blood pressure and mortality. The study by Peters et al. analyzes data from a remarkable follow-up of as many as 29 years of patients included in the General Practice Hypertension Study in the UK, and reports that even transiently elevated DBP bears a significantly increased risk of total and cardiovascular mortality, particularly in women. This finding should be seen in the context of the current debate on the outcome predictive role of blood pressure variability, although the strength of evidence is limited by little information on blood pressure and blood pressure-lowering therapy in the long time interval between initial observation and outcome occurrence. In the very elderly individuals of the Leiden 85-plus Study, Poortvliet et al. confirm the paradox that, whereas intervention trials have shown benefits from blood pressure reduction even in the very old, observational studies find a higher mortality in those with a lower SBP, especially when this has been gradually declining during the previous 5 years.
The possible advantages of central (calculated) blood pressure over that measured peripherally continue to attract wide interest from clinical investigators. A number of studies are devoted to this topic in the current issue. Pucci et al. and Ding et al. test new devices for accuracy in calculating central blood pressure in comparison with the traditional method and the gold standard of invasive measurement. The difficulties inherent to the current and the new methodologies are commented by J.D. Cameron in an editorial, raising concern on the fact that results from different devices, even if defined as ‘central blood pressure’, are not interchangeable, and therefore difficult to apply in a practical context. Furthermore, Heim et al. suggest that calculation of the augmentation index, from which central blood pressure is inferred, can also be done during diastole, rather than during systole only, with the advantage of avoiding the confounding effect of heart rate. This contribution is commented by Avolio and Butlin. The advantage of calculating central blood pressure is questioned, however, by the study of Oliveras et al., who have found that central blood pressure is not superior to peripheral blood pressure in being associated with albuminuria. Results of different studies on this issue are rather variable, and the question, therefore, is open to further investigation. Even the use of pulse wave velocity to measure large artery stiffness has been carefully scrutinized by Dzeko et al., who report that the values obtained can be different if the right or left carotid arteries are used. This issue is discussed by Salvi and Parati in an editorial commentary.
Cardiometabolic risk continues to attract investigators’ attention. A prospective study of two Korean cohorts (Lee et al.) report that even the metabolically healthy obese phenotype is associated with a high incidence of hypertension, and therefore this may not be a benign condition. These data are commented upon by Correia. Hereditary factors of cardiometabolic risk have been explored by Wei et al. in twin pair studies and in neuroendocrinal cells, with the finding that the G-protein-coupled receptor of neuropeptide Y2 contributes to control of complex cardiometabolic traits. This may open the way to new transcriptional strategies against cardiometabolic risk through intervention into neuropeptide actions.
Hypertension-related organ damage is a favourite area of hypertension research. Organ damage assessment is strongly recommended by European Society of Hypertension - European Society of Cardiology (ESH–ESC) guidelines as part of the initial evaluation of the hypertensive patient and, as reported by Rossignol et al., this recommendation is frequently, but often incompletely, implemented by French doctors and only rarely translates into risk reclassification of patients. This may be due to the fact that the majority of patients were already classified as high risk, and to the often incomplete search for organ damage. Indeed, Rossignol et al. remark that when the wider ESH–ESC recommended search was implemented, this was accompanied by the greatest effectiveness in upgrading the cardiovascular risk. Two other papers are devoted to experimental studies on development of organ damage in hypertension models (Skogstrand et al., Shobeiri et al.) and the topic is commented in an editorial by Nishiyama, who calls attention to the fact that juxtaglomerular nephrons (the earliest to be injured in the hypertension model studied by Skogstrand et al.) are rarely observed in human renal biopsies, so an early diagnosis of renal injury may be often missed. Cardiac levels of angiotensin II and aldosterone, and plasma levels of pro-inflammatory cytokines in response to a salt diet have been found to be modulated by the natriuretic peptide receptor-A gene (Npr1), suggesting a potential role of this gene against the effects of salt loading. The predictive role of another inflammatory marker, C-reactive protein (CRP), for the development of preeclampsia, has been the object of a systematic literature review by Rebelo et al., who confirm that women with high levels of CRP may have an increased risk of preeclampsia, though BMI appears to be an important confounder.
In this issue of the Journal therapeutic investigation is covered by three studies. Because cardiac benefits have been attributed to regular consumption of oats, Wong et al. report the results of the first randomized, double-blind, placebo-controlled trial of dietary administration of a wild green oat extract, showing improved vasodilatation in systemic and cerebral arteries. Whether this will translate into an antihypertensive effect remains to be proved. A study by Kojima et al. further contributes to the evidence that renin–angiotensin system blockers exert an antiproteinuric action in diabetes at least partly independent of blood pressure reduction. This important issue is discussed by Chatzikyrkou and Menne in an editorial commentary, mentioning recent studies in which drug control of microalbuminuria was not necessarily accompanied by reduction of cardiovascular events. Finally, a review by Colussi et al. summarizes the recently renewed interest for aldosterone blockers not only in endocrine but also in primary hypertension.
The increasing risk of cardiovascular disease in developing countries is paralleled by an increasing number of publications on this topic. In this issue, Nejjari et al. report the results of a large epidemiological study in three North African countries, confirming a high prevalence of hypertension, which is often underdiagnosed. On the contrary, a community-based randomized trial in Nigeria (NA-HAT), reported by Adyemo et al., and commented by B. Waeber, has found that a community-based intervention is accompanied by modest default rates compared with industrialized countries. Finally, in a community sample of blacks in South Africa inappropriate left-ventricular hypertrophy has been found to be highly prevalent and associated with systolic dysfunction (Libhaber et al.).
Conflicts of interest
There are no conflicts of interest.