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Guidelines and research upon which guidelines are founded

Zanchetti, Alberto

doi: 10.1097/HJH.0b013e3283625296

Istituto Auxologico Italiano and Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università di Milano, Milan, Italy

Correspondence to Alberto Zanchetti, Centro di Fisiologia Clinica e Ipertensione, Università di Milano, Via F. Sforza, 35, 20122 Milano, Italy. Tel: +39 02 5032 0484; e-mail:

Received 17 April, 2013

Accepted 17 April, 2013

This issue of the Journal of Hypertension is focused on the publication of the new guidelines for the management of arterial hypertension jointly prepared by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). The Journal of Hypertension has a long tradition for publication of hypertension guidelines, starting in 1986 with the WHO-International Society of Hypertension (ISH) guidelines on mild hypertension [1], and continuing in subsequent years with updatings of these guidelines [2–5] until the last joint memorandum of these two organizations in 2003 [6]. The first ESH-ESC guidelines on hypertension management were published in our Journal in 2003 [7] and the second edition in 2007 [8]. Other scientific organizations have published their guidelines in our Journal, such as the Latin American Society of Hypertension [9–11] and, more recently, the Australian consensus on ambulatory blood pressure [12]. The ESH has also published guidelines on special areas of hypertension, such as hypertension in children and adolescents [13], ambulatory or home blood pressure measurement [14,15], and hypertension and sleep apnoea [16].

The immediate antecedent of the 2013 ESH-ESC guidelines herewith published are the 2007 guidelines, but readers of the new guidelines will realize that these have been strongly influenced by a critical reassessment of all available evidence in a document prepared by an ESH Task Force and published in the Journal of Hypertension at the end of 2009 [17]. The major novelties of the 2013 guidelines are appropriately summarized at the beginning of the document, wherein it is also stated that, although guidelines directed to medical practice should give the highest priority to randomized clinical trials, they must also be founded on the results of observational and other studies of appropriate scientific calibre. Indeed, pathophysiological, pharmacological, epidemiological and other similar studies all provide the ground for the hypotheses to be tested by large randomized controlled trials. These are the types of studies that the Journal of Hypertension most often harbours, and we are proud that as many as 117 of the articles cited in the 2013 guidelines have been published in the Journal of Hypertension.

Also in the current issue, in addition to the ESH-ESC guidelines, the Journal publishes the results of a number of studies, some of which may be cited in future guidelines. Epidemiological studies concern prevalence and awareness of hypertension in Iran (Maleksadeh et al., pp. 1364–1371; see also editorial commentary by Angeli et al., 1358–1361) and prevalence of hypertension among a large cohort of HIV-positive individuals in Uganda (Mateen et al., 1372–1378). The latter article calls for efforts to combine HIV treatment with vascular disease risk factor prevention to address noncommunicable disease multimorbidity in HIV-positive persons in sub-Saharan Africa. The relation of blood pressure variability with organ damage is illustrated by a large study by Kawai et al. (1387–1395), with the possibility being raised that organ damage may parellelly be responsible for blood pressure variability and cardiovascular disease (see editorial commentary by Mancia, 000–000). Likewise, the apparent relationship between blood pressure increases during office measurement and organ damage described by Maseko et al. (1379–1386) may be due to organ damage being responsible both for higher blood pressure variability and higher response to the stress of measurement.

Vascular function appears to be better preserved in women (Schnabel et al., 1437–1446), although in women of the Women's Ischemia Syndrome Evaluation study with chest pain but nonobstructive coronary disease, changes in systolic wave reflections may contribute to reduce coronary perfusion (Nichols et al., 1447–1455). Impairment in vascular functions can also be found in patients with obstructive sleep apnoea without traditional cardiovascular risk factors (Bruno et al., 1456–1464).

Three articles concern the role of inflammation in experimental preeclampsia (Chatterjee et al., 1414–1423), in the response to salt intake (Mallamaci et al., 1424–1430) and in predicting development of hypertension in the Framingham Offspring cohort (Ho et al., 1431–1436). Genetic studies explore the association of variations in the HSD3ß gene with primary aldosteronism (Wu et al., 1396–1405), and the mechanisms of upregulation of the Na+-K+-2Cl cotransporter 1 in hypertensive rats (Cho et al., 1406–1413).

Interest in resistant hypertension is illustrated by a large study in China, showing that the prevalence of primary aldosteronism among Chinese patients with resistant hypertension is lower than reported for other ethnic populations (Sang et al., 1465–1472). Pessina et al. (1473–1476) report a case of resistant hypertension, leading to unnecessary renal denervation and adrenalectomy, and due to factitious use of amphetamine (Munchausen syndrome).

Three articles on therapeutics describe the role of depression in nonadherence to antihypertensive treatment (Sjösten et al., 1477–1484; see also editorial commentary by Borghi, 1362–1363); absence of any sustained raise in blood pressure caused by acetaminophen in treated hypertensive patients (Dawson et al., 1485–1490) and the rules French physicians follow in prescribing aliskiren to their patients (Sosner et al., 1491–1496).

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Conflicts of interest

There are no conflicts of interest.

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