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From pregnancy to childhood and adulthood: the trajectory of hypertension

Zanchetti, Alberto

doi: 10.1097/HJH.0000000000000958
EDITOR'S CORNER
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Istituto Auxologico Italiano and Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università degli Studi di Milano, Milan, Italy

Correspondence to Professor Alberto Zanchetti, Direzione Scientifica, Istituto Auxologico Italiano, Via L. Ariosto, 13, 20145 Milan, Italy. Tel: +39 02 61911 2237; e-mail: alberto.zanchetti@auxologico.it

A number of articles in the current issue of the Journal of Hypertension help in illustrating the trajectory of blood pressure (BP) and hypertension from pregnancy to childhood and adulthood.

A group of studies have investigated the molecular mechanisms of preeclampsia. Dalle Vedove et al. (pp. 1364–1370) report increased epoxyeicosatrienoic acids and reduced soluble epoxide hydrolase in the preeclapsia placenta, and suggest reduced expression of soluble epoxide hydrolase in preeclampsia may be the key factor of increased epoxyeicosatrienoic acids in the placenta. Wu et al. (pp. 1371–1379) propose that the impaired miR-195 expression they found in the preeclamptic placenta may contribute to the occurrence or development of preeclampsia through interfering with activin/nodal signaling in the placenta. Also Gao et al. (pp. 1380–1388) bring some new evidence on the pathogenesis of preeclampsia by showing vascular endothelial cells may be damaged and cellular proliferation is depressed in human placenta–umbilical cord circulation.

In a prospective study of a large cohort (n = 6239) of children, in whom a number of body measurements were done at different times from birth to age of 6 years, Toemen et al. (pp. 1396–1406) describe specific fetal and infant growth patterns associated with different BPs in childhood, in particular, children with decelerated or normal fetal growth followed by accelerated infant growth had higher BP at age of 6 years. Lurbe et al. (pp. 1389–1395) publish the results of an interesting study of central BP and pulse wave amplification across the spectrum of peripheral BP in a large number of overweight and obese children and adolescents, showing that the largest differences between office brachial SBP and central SBP corresponded to the isolated systolic hypertension group, among which ambulatory BP monitoring identified a high prevalence of white-coat individuals. In an accompanying editorial comment, Avolio and Butlin (pp. 1254–1256) underline that the major problem with noninvasive measurement of central BP in children is that it uses devices developed for adults. Although it is likely that measurements are faithful at age 12 years and above (age 12 is the mean age in the study by Lurbe et al., pp. 1389–1395), Avolio and Butlin (pp. 1254–1256) point out that studies on younger children will require the use of age and growth-dependent models.

Concordances and discordances between central (aortic) and brachial SBP have also been investigated in adults (mean age 54 years) by Protogerou et al. (pp. 1325–1330), who find that discordant values (isolated high brachial or isolated high aortic SBP) are not infrequent (about 10% altogether), and are accompanied by an intermediate value of carotid wall thickness (higher than in concordant normotensives and lower than in concordant hypertensive patients). The problem of accuracy of commercial devices and methods for noninvasive estimation of aortic SBP is systematically reviewed by Papaioannou et al. (pp. 1237–1248), who report automated recording of wave forms, calibrated noninvasively by brachial mean arterial pressure/DBP values seems the most promising approach. This article is commented upon by Salvi and Parati (pp. 1249–1251), who remark that the almost totality of validation studies or devices for noninvasive assessment of central blood pressure have focused only on the comparison of central blood pressure values measured by the reference invasive versus tested noninvasive method, with no simultaneous assessment of the reliability of the underlying methodology.

Factors responsible for the trajectory of BP values through the years leading to incident hypertension have been explored in a series of prospective studies: in a Spanish cohort, Sánchez-Iñigo et al. (pp. 1257–1265) describe an association between triglycerides-related variables and incident hypertension independent of adiposity; Fyfe-Johnson et al. (pp. 1266–1272) find a role for serum fibroblast growth factor-23, and Hu et al. (pp. 1273–1278) by analyzing data in the Bogalusa Heart Study, report a positive association of incident hypertension with hand tremor measurements in young to middle-aged adults, present in whites though absent in blacks.

The importance of carotid–femoral pulse wave velocity (cfPWV) in determining cardiovascular risk has also been investigated. Greve et al. (pp. 1279–1289), analyzing data from the prospective Danish MONICA 10 cohort and repeating the analyses in a Paris cohort, find that estimated and measured cfPWV values predict cardiovascular events independent of SCORE and Framingham risk score, and indicate that these traditional risk scores underestimate the complicated impact of age and BP on arterial stiffness and cardiovascular risk. The risk represented by increased cfPWV has also been studied by Lilamand et al. (pp. 1331–1337), who report that in a group of elderly community-dwelling patients attending a memory clinic, pulse wave velocity was significantly associated with severe medial temporal lobe atrophy (as diagnosed by MRI). In another article, Maia-Leite et al. (pp. 1338–1346) have found no difference in aortic stiffness between HIV-infected patients and control.

In the prospective population study, PAMELA, Cuspidi et al. (pp. 1423–1431) have followed the trajectory of left ventricular geometric patterns, and reported that age and initial left ventricular mass index are the strongest determinants of all types of progression. In two cross-sectional studies, Lupat et al. (pp. 1416–1422) found that in Brunei, prevalence of hypertension was very high in both men and women, and the stroke risk attributable to hypertension was large, and Rohla et al. (pp. 1432–1440) report that in Austria, despite an average use of at least two antihypertensive drugs, often in fixed-dose combination, only 41% of the treated hypertensive patients have their BP controlled to below 140/90 mmHg.

Other interesting areas of hypertension research have been investigated by articles published in the current issue of the Journal of Hypertension. Weaver et al. (pp. 1290–1297) have found a high degree of intraindividual variability in 24-h urinary sodium excretion in adolescents kept on a fixed sodium intake, and underline the potential for substantial error in using 24-h urine collections to estimate usual sodium intake and relate it with cardiovascular outcomes. G. Grassi et al. (pp. 1298–1308) report that flavanoid-rich chocolate was able to counteract vascular impairment after sleep deprivation and simultaneously restored working memory performance. In an accompanying editorial comment, Lembo and G. Grassi (pp. 1252–1253) suggest that it would be interesting to extend this investigation to the effects of chocolate on chronic sleep deprivation, a situation which may have an even more pronounced clinical impact.

Robinson et al. (pp. 1309–1316) find that aerobic exercise training prevents arterial dysfunction caused by acute exertion in overweight and obese adults, the effect of training consisting in switching vascular dilatation from a predominantly nitric oxide-mediated mechanism to a predominantly H2O2-mediated one. Santos et al. (pp. 1317–1324) report that a single session of light or moderate aerobic exercise acutely reduces ambulatory BP in resistant hypertension, although vasodilatation persists longer following light intensity exercise.

Two other articles have investigated endocrinological aspects of hypertension. Tomaschitz et al. (pp. 1347–1356) find that eplerenone lowers ambulatory blood pressure in patients with primary hyperparathyroidism though having no effect on parathyroid hormone levels; Costenaro et al. (pp. 1357–1363) report that in patients with acromegaly BP assessed by ambulatory monitoring were associated with hormonal indices of acromegaly (GH, IGF1) and echocardiographic signs of acromegalic myocardiopathy.

Finally, Iwashima et al. (pp. 1407–1415) publish the results of a 5-year follow-up of hypertensive patients with renal artery stenosis treated by percutaneous transluminal renal angioplasty, and report a significant frequency of restenosis, which, particularly in fibromuscular dysplasia, was often accompanied by decreased benefits of treatment.

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ACKNOWLEDGEMENTS

Conflicts of interest

There are no conflicts of interest.

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