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Highlights of the issue

Mancia, Giuseppe

doi: 10.1097/HJH.0000000000001786
Editor's Corner

Università Milano-Bicocca, Milan, Italy

Correspondence to Professor Giuseppe Mancia, dei Daini, 4 -20126 Milan, Italy. Tel: +39 3474327142; e-mail:

Received 14 April, 2018

Accepted 14 April, 2018

The July issue of the Journal of Hypertension includes articles on the pathophysiology as well as the diagnostic and treatment aspects of hypertension alone or in association with other diseases. The first article is a comprehensive review of the importance of obesity for cardiovascular disease, jointly prepared by the Working Group on Obesity and Diabetes of the European Society of Hypertension (ESH) and the European Association for the Study of Obesity (Kotsis et al., pp. 1427–1440). The first part addresses the mechanisms through which obesity favours the appearance of other risk factors, that is, hypertension, dyslipidemias and diabetes, whereas the second reviews the predictive value of obesity for cardiovascular outcomes (including some more rarely mentioned events such as atrial fibrillation and sudden death) as well as the lifestyle changes to implement in order to avoid or correct an excessive body weight. Emphasis is placed on the importance of early interventions, given the worrisome increase in the prevalence of obesity in the youth and its long lasting consequences for adult life.

This is followed by an editorial of Lurbe et al. and a review by Maruhashi et al. (pp. 1460–1467). Lurbe and colleagues (pp. 1456–1459) discuss the latest development of the hypertension guidelines in children and adolescents as well as the similarities and differences between the guidelines issued by the ESH and the updated document released by the American Academy of Pediatrics. Knowledge and opinions are changing rapidly in this area, and important issues such as how to define hypertension in children and adolescents as well as when to start applying adult criteria are matter for continuing discussion, to which European research appears to importantly contribute. Maruhashi and colleagues (pp. 1460–1467) address a frequently forgotten aspect of hypertension, namely the role played by endothelium-independent vasodilation vis-à-vis the much more commonly addressed vasodilation promoted by endothelial factors. The methodology to study endothelial-independent vasodilation is reviewed together with the mechanisms that lead to its impairment and the clinical consequences that this may have. It is hoped that this will favour future studies in this area.

The July issue of the Journal of Hypertension includes 16 original research articles. On the basis of data from a large Oman family (more than 1300 individuals) Muñoz et al. (pp. 1477–1485) provide evidence that heart rate variability is not only modulated by environmental factors, but it has a genetic component that is particularly evident during mental or physical stresses. Joe et al. (pp. 1486–1491) show the results of a genetic study, which provides a fine mapping of two previously identified epistatic blood pressure (BP) quantitative trait loci positioned in the chromosome 5 of the rat. One locus (BPQTL1) was better defined whereas the other (BPQTL2) was found to be formed by at least three QTLs with contrasting effects on BP, that is, two QTLs were found to be associated with a BP increase and one with a BP reduction.

There are then six articles which address different aspects of the epidemiology of hypertension. Bombelli et al. (pp. 1492–1498) extend the already large body of evidence on the clinical relevance of hyperuricemia by showing that at the population level (PAMELA population) an increased serum uric acid increases the 10-year risk of developing an impaired fasting glucose condition, type 2 diabetes or a metabolic syndrome, all being more evident in the older fraction of the population. Kansui et al. (pp. 1499–1505) show that in Japanese workers, increased serum uric acid levels are associated with an increased risk of incident hypertension. This has been reported in the past, but the article of Kansui and colleagues adds to previous evidence that the association between serum uric acid and new onset hypertension can be seen in relatively young (<45 years of age) individuals, with no confounding comorbidities that interfere with the conclusion that uric acid is the responsible factor. Wang et al. (pp. 1506–1513) describe the promising results obtained by applying a multistate Markov model to predict, over the long-term, transition from one to other BP stages, using a large Chinese population and including in the prediction not only changes from lower to higher but also from higher to lower BP values. Kowalski et al. (pp. 1514–1523) show that adolescents born extremely pre-term exhibit, compared with controls, an increased central BP, which is apparently not accounted for by an increase in large artery wall thickness, but by an increase in the reflected wave phenomenon. This provides an interesting piece of information to the evidence that birth (and even foetal) abnormalities may have long-term hemodynamic and metabolic effects, providing a further chance to further understand the factors involved in the genesis of cardiovascular disease in adulthood. Mwasongwe et al. (pp. 1524–1532) provide data suggesting that in African Americans, masked hypertension may be associated with an increased risk of developing chronic kidney disease, in line with the widespread notion that this condition is clinically adverse and that more should be done to detect it on a routine basis. The results have an element of uncertainty, however, as full adjustment for differences between masked hypertension and control individuals by use of the propensity score method did not confirm that, as far as incident kidney disease was concerned, individuals with a masked hypertension and controls differ. The issue is placed in perspective by the editorial commentary of Parati et al. (pp. 1468–1471) and should stimulate a discussion on how to effectively adjust for confounders in observational studies, given that these studies are the main (or only) source of long-term clinical data. Finally, Batavia et al. (pp. 1533–1539) show that in more than 800 Haitian adults (mean age 39 years) with HIV infection high BP is common and has an association with a marked (>2 times) increase in the risk of death. Thus, hypertension is a substantial component of the threat to long-term survival in individuals with chronic HIV-related inflammation.

The remaining original research articles deal with alterations of lipid profile in hypertension (n = 3), resistant hypertension (n = 3) and primary aldosteronism (n = 2). In the lipid area, Perini et al. (pp. 1540–1547) report that in the Netherlands, treatment rates for hypertension and dyslipidemia are not less, but in some cases even greater, in ethnic minorities compared with the remaining population. This is a reassuring finding that should prompt similar studies in other countries to see whether the Dutch data reflect what happens in the entire European continent, given the substantial multiethnicity of the whole European population. Filipovic et al. (pp. 1548–1554) show that, cross-sectionally, young healthy adults exhibit an inverse relationship between diets rich of omega-3 fatty acids and BP levels, those in the highest omega-3 fatty-acid quartile having a BP 4/2 mmHg (systolic/diastolic) lower than that of the remaining individuals. This should favour inclusion of this dietary component in the recommendation on how to lower BP by nonpharmacological means in hypertensive patients and the general population. Lorbeer et al. (pp. 1555–1562) report that in 345 normotensive or hypertensive patients, MRI-derived adipose tissue measurements showed a closer association with the hypertension status then classical anthropometric markers of body fat (BMI, waist circumference, waist–hip ratio, etc.), suggesting that they may more effectively assess the obesity component of a high BP status. This can be seen as an advantage for research whereas larger use of MRI examinations in medical practice would obviously be opposed by cost considerations.

In the resistant hypertension area, De la Sierra et al. (pp. 1563–1570) provide a detailed description of the antihypertensive drugs that are more successfully used in this condition, based on a large database (n = 14 264) of Spanish patients on at least three antihypertensive drugs. Antialdosterone antagonists, but also drugs from other classes were associated with a better antihypertensive effect, suggesting that their greater use might be of advantage. Eikelis et al. (pp. 1571–1577) described the relationship of a specific polymorphism of a noradrenaline transporter gene with higher BP values in patients with resistant hypertension. This has considerable interest as previous studies have shown resistant hypertension to be associated with sympathetic hyperactivity, which according to the present observations seems to have a genetic nature. The issue is further discussed in the editorial commentary of Jordan and Grassi (pp. 1472–1474). Fengler et al. (pp. 1578–1584) address the factors involved in the profound therapeutic response (−20 mmHg SBP) that sometimes can be seen after renal denervation, and conclude that they include, among other factors, markers of vascular integrity, higher baseline BP values and combined diuretic therapy. How to predict the effects of renal denervation is an issue of paramount importance but also of great complexity, as discussed in the editorial commentary by Schlaich et al. (pp. 1475–1476).

The last two articles focus on the diagnostic aspects of primary aldosteronism. The former article (Vorselaars et al., pp. 1585–1591) shows that the aldosterone-to-renin ratio was capable, at a cutoff value greater than 5, of detecting primary aldosteronism with a 100% sensitivity and a 86.7% specificity. Thus, use of aldosterone-to-renin ratio remains a valid diagnostic approach to this condition. The latter article, however, suggests that the cutoff values for plasma aldosterone concentration and aldosterone-to-renin ratio should be revisited when the new gold standard method for plasma aldosterone concentration, that is, LC-MS/MS, is used, somewhat lower values being probably diagnostically more appropriate. Improving the detection of primary aldosteronism may favour a more precise determination of its contribution to the prevalence of essential hypertension, a still controversial issue.

As many readers know, the Editor-in-Chief of the Journal of Hypertension died last March at the age of 92 years. The obituary at the end of this issue remembers the crucial role he has played, in his long productive life, for the basic and clinical research on hypertension as well as for the birth and growth of the two scientific Societies that officially endorse and scientifically support the Journal. During his 23 years as Editor-in-Chief Alberto Zanchetti has enormously contributed to the success of the Journal with his deep scientific knowledge and dedication to his work, giving it a forefront position in the hypertension field. The members of the local Executive Board who have worked with him over this long period will miss him immensely.

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Conflicts of interest

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