The November issue of the Journal of Hypertension opens with an article of Postel-Vinay et al. (pp. 2125–2131) on a topic of great interest, that is, the solutions offered by communication technologies for implementation of home blood pressure (BP) measurements, namely measurements that are now supported by both European and US guidelines for the chronic management of hypertension. The most important studies on telemedicine, smartphone apps and other internet-based devices are reviewed, providing the reader with an update on the current status of techniques that allow remote transmission of BP data obtained by self-BP measurement devices. The results look highly promising and the hope that this approach will improve antihypertensive treatment and expand BP control of the hypertensive population (possibly also facilitating the conduction of antihypertensive treatment trials) appears to be justified. The evidence is still limited, however, and future studies on the advantages of these approaches for well known therapeutic problems such as low adherence to treatment and high-therapeutic inertia as well as low rate of BP control and high residual risk of treated individuals are needed and should be encouraged.
Four articles provide evidence on the alterations of cardiovascular control mechanisms that can be seen in young individuals either with a family history of hypertension or with an already established BP elevation. Hirst and Marshall (pp. 2140–2147) show that the endothelium-dependent vasodilatation is blunted in offspring of hypertensive parents, whereas Xie et al. (pp. 2157–2167) report that in these individuals the SBP variations that reflect cardiorespiratory coupling are abnormal when compared with controls. Alterations of T cells that reflect a decline of thymic function (and a possible immunity defect) are reported by Gackowska et al. (pp. 2148–2156) in children with primary hypertension and cardiac or vascular alterations, whereas a relationship between alterations in ACE polymorphism (ACE DD or GG) and the adiposity-related risk of incident hypertension in adulthood is described by Sun et al. (pp. 2168–2176) in three cohorts of children and adults. To-date most alterations of BP control mechanisms seen in established hypertensive patients have been observed also in early hypertension phases or before hypertension develops. They are thus likely to play a causative role, not just to be a consequence of the BP elevation.
The subsequent four articles deal with new BP measuring devices (one article) and the clinical impact of BP variability (three papers). García-Ortiz et al. (pp. 2204–2214) report the results of testing a new wrist-worn device for its ability to correctly measure central BP and the augmentation index. The intra-observer and inter-observer reliability of the device was good, and compared favourably with the data obtained with the classical SphygmoCor. There was also an association of the device-provided measures with measures of organ damage, which extends validation to clinical aspects. Thus, the number of devices that allow to obtain reliable central BP values is increasing, the new devices possibly making data collection more complete than the old ones. The topic is critically reviewed in the Editorial Commentary of Sharman and Avolio (pp. 2138–2139), who emphasize, as an advantage of the new device, its ability to provide continuous BP assessment. The three articles on BP variability further strengthen the already large body of evidence that this phenomenon is clinically adverse. Brennan et al. (pp. 2177–2184) show that in a high number of diabetic patients with foot ulcers (n = 5111 vs. 129 247 controls) the ulceration was independently related to SBP variability as quantified by three BP measurements in the preceding year, a finding that is placed in perspective by the Editorial Commentary of Palatini (pp. 2132–2134). Matsumoto et al. (pp. 2185–2192) show that frequent nocturnal urination is independently related to a reduced night-time BP fall. As discussed in the Editorial Commentary of Muiesan and Paini (pp. 2135–2137), this should prompt physicians to devote more attention and measure ambulatory BP in patients with nocturia, given the well documented increase of cardiovascular risk associated with nocturnal nondipping. Hisamatsu et al. (pp. 2193–2203) show that between-day BP variations (calculated from seven consecutive days of home BP measurements) were associated with greater carotid, aortic and peripheral atherosclerosis, independently of mean BP values. Longitudinal evidence on the adverse prognostic importance of day-to-day BP variability is still scanty, which makes the contribution of these cross-sectional data relevant.
The remaining articles deal with clinical and mechanistic aspects of hypertension. Kobayashi et al. (pp. 2269–2276) describe the results of testing a new prediction score for bilateral primary aldosteronism in a large number (n = 1936) of patients with this condition. A simple score based on absence of adrenal nodules at computed tomography and female sex with baseline serum potassium levels, plasma aldosterone concentration and aldosterone/renin ratio at selected cutoff values exhibited a predictive ability of 93.5%, with a performance superior to that of the existing prediction scores. This holds hope to better select patients who require adrenal vein sampling as a further diagnostic step. Kusunoki et al. (pp. 2260–2268) provide an accurate description of the circadian hemodynamic profile associated with primary aldosteronism. Compared with the 120 patients with essential hypertension, the 60 patients diagnosed as having primary aldosteronism exhibited higher peripheral BP values, an increase of central BP (for which the primary aldosteronism condition was predictive) and, in addition, a reduced nocturnal BP fall. The implication is that these abnormalities, the blunted nocturnal hypotension in particular, may account for the worse prognostic impact of this condition documented in several studies. Abdelmalak et al. (pp. 2251–2259) report that in a high number of patients undergoing noncardiac surgery (n = 58 276) no association was found between preinduction hypertension stages and the risk of surgically related complications. Interest in perioperative hypertension has grown in recent years and instructions on how to deal with this condition have been included in the recent European guidelines. It is hoped that further data will be made available in the future to extend the evidence to different hospital settings and severities and types of surgical interventions.
Several mechanistic aspects of hypertension are addressed in the final four articles. Li et al. (pp. 2215–2225) provide further data (role of semaphoring 4D) on the factors that favour, in human placenta, trophoblast cell invasion, making dysfunction of the receptor tyrosine kinase Met a promoter of preeclampsia. Weber et al. (pp. 2226–2236) offer novel evidence on the mechanisms that make aged mice less capable of counteracting the BP increase induced by AgII infusion, favouring collagen deposition, causing decreased vascular density and increasing renal vascular resistance. Jiménez et al. (pp. 2237–2244) describe a cross-sectional inverse association between serum testosterone or sex hormone-binding globulin concentration and ambulatory BP in men. Duprez et al. (pp. 2245–2250) address the value of several collagen biomarkers for prediction of the development of hypertension in normotensive individuals free of cardiovascular events. Over an almost 10-year follow-up, 36% of the 1252 individuals under study developed hypertension, which was independently predicted by type I carboxy-terminal telopeptide and the procollagen type III N-terminal propeptide measured at baseline. This supports the notion that changes in extracellular matrix may precede and favour hypertension. It further suggests, however, that there can be ways to assess this specific risk by simple measurements, implementing rigorous lifestyle changes when needed.
Conflicts of interest
There are no conflicts of interest.