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Ambulatory blood pressure monitoring, arterial function and other problems concerning hypertension

Zanchetti, Alberto

doi: 10.1097/HJH.0b013e328364330e

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 Milano, Italy. Tel: +39 02 50320484; e-mail:,

A large part of the current issue of the Journal of Hypertension is devoted to a Consensus Document prepared by the European Society of Hypertension Working Group on Blood Pressure Monitoring on behalf of the Society. Additional participation of experts from Japan, China, Australia, Africa and North America gives this document an even wider impact. The document is very comprehensive, and the Editor of the Journal believes to have done a useful service to the readers by publishing it in its entirety despite its considerable length. Indeed, monitoring of ambulatory blood pressure, and more broadly blood pressure measurement, are topics of wide interest both for the scientist and the practitioner, are still subjects of debate and different positions have been taken by various scientific and regulatory organizations. Thus, the recommendations provided by the European Society of Hypertension had to be supported by a thorough review of all available studies, and the arguments through which consensus was finally achieved had to be described for the benefit of the critical readers. For those who would only like to take the practical recommendations, these are summarized in Tables and Boxes, which can be consulted quickly.

Ambulatory blood pressure monitoring is also the topic of another article in this issue, in which Liu et al. (pp. 1812–1818) discusses whether the calculation of the so-called blood pressure load may improve the correlation between blood pressure and organ damage. This article is accompanied by an extensive commentary by Parati et al. (pp. 1776–1779), who review strengths and limitations of blood pressure load calculation.

Another diagnostic aspect which is raising increasing interest is assessment of artery function. A short but in-depth review of available methods to determine the functional parameters of stiffness and resistance is published in this issue. On the basis of a careful analysis of data from large cohort studies, Westerhof and Westerhof (pp. 1769–1775) conclude that existing, noninvasive methods to determine systemic vascular resistance, total arterial stiffness and aortic characteristic impedance should be improved and new methods developed to quantify the response of arterial function to treatment.

Other studies are also focused on aspects of arterial function. Lee et al. (pp. 1853–1860) show that measurements of carotid-femoral pulse wave velocity and augmentation index are not reliable in patients with abdominal aortic aneurysms. Hering et al. (pp. 1893–1900) report that renal nerve ablation reduces augmentation index in patients with resistant hypertension, and argue that this is independent of the induced sympathetic inhibition and blood pressure reduction. In their editorial commentary Grassi and Mancia (pp. 1782–1784) discuss various types of interpretations of these unexpected findings. Cremer et al. (pp. 1847–1852) show that central blood pressure estimation by a noninvasive method using brachial blood pressure and the QKD interval is comparable in precision to the Sphygmocor. A substudy from the Hypertension in the Very Elderly Trial (HYVET) suggests that development of dementia in these octogenarian individuals may be correlated with wider pulse pressure (R. Peters et al. (pp. 1868–1875). Other studies in this issue related to blood vessels focus on possible technical errors in measuring the echolucency of the carotid intima–media (S.A.E. Peters et al., pp. 1861–1867), on endothelial function improvement by chronic administration of resveratrol (Wong et al., pp. 1819–1827) and on the effect of calcium supplementation in preventing endothelial cell activation, a finding that may help explaining the benefits of this intervention in reducing the risk for developing pre-eclampsia (Chen et al., pp. 1828–1836).

As usual, the current issue of the Journal of Hypertension also includes a series of epidemiological studies. An analysis of the Hong Kong's Chinese Birth Control by Kwok et al. (pp. 1785–1797) shows that high birth weight or larger early size were associated with lower blood pressure if followed by slower later growth, the results being consistent with the fetal origin hypothesis. Feng et al. (pp. 1798–1805) report that the association between smoking quantity and hypertension is probably mediated by inflammation signaled by C-reactive protein (CPR). Peck et al. (pp. 1806–1811) provide data with important implications for public health in sub-Saharan Africa: in a Tanzanian hospital noncommunicable diseases (NCD) account from half of all deaths, admissions and hospital days, hypertension accounts for 34% of NCD deaths, and more than half of hypertension-related deaths occur before retirement age. Shemesh et al. (pp. 1886–1892) report a 15-year follow-up of patients who had at least two coronary computer tomography scans: more rapid progression of coronary calcification was accompanied by a higher rate of incident cardiovascular events.

The content of the current issue is complemented by a pharmacokinetic study of K-canreonate in children (Suyagh et al., pp. 1901–1908), by an experimental study of the mechanism of the beneficial effects of omega-3 fatty acids on myocardial arrythmogenic factors (Radosinska et al., pp. 1876–1885), and by an investigation of the role of brain AT2 rceptors and nitric oxide in the cardiopulmonary baroreflex control of renal sympathetic nerve activity (Abdulla and Johns, pp. 1837–1846).

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Conflicts of interest

There are no conflicts of interest.

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