Istituto Auxologico Italiano and Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università di Milano, Milan, Italy
Correspondence to Professor Alberto Zanchetti, Centro di Fisiologia Clinica e Ipertensione, Università di Milano, Via F. Sforza, 35, 20122 Milan, Italy. Tel: +39 02 5032 0484; e-mail: email@example.comfirstname.lastname@example.org
The current interest of investigators and clinicians in hypertension-related organ damage is well witnessed by a substantial number of papers devoted to this research area in the current issue of the journal.
In an unselected population cohort (the Finn-Home Study), Hänninen et al. (pp. 1136–1143) have found that signs of organ damage (electrocardiographic voltages, carotid intima–media thickness, pulse wave velocity) had significantly higher values in masked and sustained hypertension than in normotension, with white-coat hypertensive patients showing intermediate values. In another community sample from a different part of the world (South Africa), Booysen et al. (pp. 1124–1130) also found that among individuals with normal or high normal blood pressure those with or without organ damage (assessed by pulse wave velocity, estimated glomerular filtration rate, left ventricular mass) had similar clinic blood pressures, but different calculated aortic SBP. In an editorial commentary, Perlini and Grassi (pp. 1083–1085) remark that these data suggest a continuum of target organ damage related to the blood pressure load, which in the Finn-Home Study could be better assessed by home blood pressure and in the South African study by central blood pressure estimation.
Other studies focus on specific types of organ damage. Milan et al. (pp. 1189–1195) call attention on the high prevalence of aortic root dilatation among treated and untreated hypertensive patients, and suggest criteria for a correct diagnosis. Peralta et al. (pp. 1196–1202) report a high prevalence of occult chronic kidney disease among hypertensive patients included in the US National Health and Nutrition Surveys underlining the diagnostic role of cystatin C or albumin-to-creatinine ratio. Antikainen et al. (pp. 1224–1232) have investigated electrocardiographic left ventricular hypertrophy in the very old hypertensive patients of the Hypertension in the Very Elderly Trial (HYVET) and found that the Cornell product criteria appear to be the most useful measure owing to its close relationship to SBP. Collins et al. (pp. 1214–1223) provide evidence that diurnal variations in excitation-contraction coupling are lost in the spontaneously hypertensive rat heart.
Cognitive function is often considered to be unfavorably affected by blood pressure, but evidence is scanty and controversial. Controversial observations are also presented in the current issue of the journal. Lyngdoh et al. (pp. 1175–1182) have examined the association between cognitive endpoints and blood pressure in school children and found no association. Levy-Marpillat et al. (pp. 1073–1082) have assessed available evidence on prevention of cognitive decline and dementia with blood pressure-lowering treatment by a systematic review and network meta-analysis. The results support the notion that antihypertensive treatment may have beneficial effects on cognitive decline, although these positive results derive from the combination of observational and randomized studies, randomized studies alone producing nonsignificant results.
A substantial number of papers are also focused on therapeutic issues. In a large nationally representative sample of adults in USA, Spatz et al. (pp. 1096–1105) have found that hypertension and treated hypertension have a different relationship with sexual health in older men and women, but no significant associations between antihypertensive medication class and sexual activity or problems could be detected. A related finding, reported by Ziemens et al. (pp. 1106–1113), is that high testosterone concentrations are a potential risk marker of hypertension in women.
R. Sato et al. (pp. 1233–1238) report that an angiotensin receptor blocker can restore synchronization of circadian rhythms in blood pressure and heart rate, lost in hypertensive patients with chronic renal disease. Flevari et al. (pp. 1239–1244) have found spironolactone can improve endothelial function in patients on hemodialysis. N. Stato et al. (pp. 1245–1255) have compared the association of an angiotensin receptor blocker with either a diuretic or a calcium channel blocker, finding the former association results in a greater reduction in albuminuria and the latter yields a greater reduction in blood pressure. In the Survival of Myocardial Infarction Long-term Evaluation-4 study, zofenopril was more effective than ramipril in reducing cardiovascular outcomes in hypertensive (but not normotensive) acute myocardial infarction patients simultaneously receiving aspirin (Borghi et al., pp. 1256–1264). Carrington et al. report the results of an important survey of trends in blood pressure levels and management of hypertension in primary care in Australia. Their findings suggest little or no gain in the community control of hypertension, however with the suggestion that longer term benefits may result from ongoing annual visits. In an accompanying editorial, Mancia (pp. 1265–1271) comments that Carrington's data as well as others from different countries show that the current opinion that, after many years of therapeutic progress, hypertension is less of a problem cannot be more wrong.
Another highly debated therapeutic issue is the role of percutaneous transluminal angioplasty in curing renovascular hypertension. In a review of their experience on 51 cases with fibromuscular dysplasia, Smit et al. (pp. 1183–1188) report that even in this type of renovascular hypertension, there was little cure, though less antihypertensive medication was needed. In an accompanying editorial commentary, Morganti and Lonati (pp. 1091–1093) review the area of angioplasty both in cases of fibromuscular and atherosclerotic renal artery stenoses, and remark that failures of angioplasty in both types of stenosis may largely depend on the age of patients (no country for old men). They mention the more favorable experience of the Italian Group for the Study of Renovascular Hypertension, suggesting that careful evaluation of patients by ultrasound monitoring of renal artery blood flow and renin profiling may help detecting those patients potentially suitable for angioplasty.
Two papers are devoted to problems associated with blood pressure measurement. It is known that the white-coat blood pressure reaction is lower when blood pressure is measured by a nurse rather than a doctor. Grassi et al. (pp. 1131–1135) show now that the blunted pressor response to the nurse blood pressure measurement is indeed accompanied by an attenuation of the adrenergic neural responses. The other difficult problem of identifying blood pressure thresholds to define hypertension in children of different ages is approached by Chiolero et al. (pp. 1170–1174), who propose the simple height-specific blood pressure thresholds that they have validated.
Three papers focus on diet. Despite the experimental suggestion that protein ingestion negatively affects renal function, an analysis of the EURODIAB Prospective Complications Study by Altorf-van der Kuil et al. (pp. 1151–1159) does not provide evidence for an association between protein intake and hypertension or microalbuminuria in type 1 diabetic patients. Nonetheless, in their editorial commentary to this paper, Angeli et al. (pp. 1086–1090) remind that different dietary proteins may exert different effects on blood pressure and the kidney, with preliminary data favoring whey and fish proteins. A paper from the International Study on Macro/Micro-nutrients and Blood Pressure (Miura et al., pp. 1144–1150) reports that dietary monounsaturated fatty acid intake, especially oleic acid, may prevent adverse blood pressure levels in the general population. Naito et al. (pp. 1203–1213) have found that dietary iron restriction prevents further deterioration of renal damage in a rat model with chronic kidney disease.
Finally, interesting pathophysiological studies, with possible therapeutic implications, are also reported. Rubattu et al. (pp. 1061–1072) review the role of the atrial natriuretic peptide (ANP) in vascular function modulation in hypertension, and discuss the therapeutic implications of ANP, through the potential use of ANP analogues, neuroendopeptidase inhibitors as well as ANP-based gene therapy. In a population-based cohort of elderly participants, the Hoorn study, van der Zwan et al. (pp. 1114–1123) have found L-homoarginine and L-arginine are antagonistically related to blood pressure. In a nonobese model of type 2 diabetes, the Goto–Kakizaki rat, Rao et al. (pp. 1160–1169) have found that fasudil, an inhibitor of the RhoA-rho kinase (ROCK) pathway, normalizes the elevated blood pressure of these animals, and the contractile responses of mesenteric resistance arteries from these animals are more dependent on ROCK than are the responses of control arteries.
Conflicts of interest
There are no conflicts of interest.