The July issue of the Journal of Hypertension starts with a meta-analysis on the clinical significance of hypertensive emergencies and urgencies, that is, conditions that account for a considerable portion of the patients seen in emergency departments. In about 5000 patients from eight studies, Astarita et al. (pp. 1203–1210) show that blood pressure (BP) levels did not exhibit an association with hypertension-related organ damage, which could much more reliably be inferred from the clinical signs and symptoms of the patients. This is an area on which research interest has been low for years, but that is now receiving more attention, which makes the present contribution a timely one. Saeed et al. (pp. 1211–1219) provide a narrative review of the available information on the role of hypertension in aortic stenosis, including the effect of antihypertensive treatment before and after surgical correction. This is another area on which interest and research are growing, and more data on its variable aspects can be expected in the future.
This journal issue provides three position papers from the Working Groups of the European Society of Hypertension and a review on the future of antihypertensive treatment from two expert hypertensiologists. The first position paper (Viigimaa et al., pp. 1220–1234) updates the information available on erectile dysfunction in hypertension, an issue of practical importance because of its high prevalence, association with treatment discontinuation, and thus nonmarginal responsibility for the low BP control characterizing antihypertensive treatment worldwide. The update addresses the factors already known to be associated with this condition, but it additionally focuses on new data supporting the hypothesis that erectile dysfunction may precede the hypertension-related damage, and thus be, at least in part, due to inherent alterations of small vessel structure and function. Stergiou et al. (pp. 1235–1243) provide an overview of the available data on seasonal BP variations, which they show to be evident both in untreated and treated hypertensive individuals, irrespective of the BP-measuring environment, that is, in the office or out of the office. The implications of seasonal BP changes for antihypertensive treatment are also discussed. Palatini et al. (pp. 1244–1250) address the problem of BP measurements in people with large arms as well as in those with shorter arms relatively to the arm circumference. Practical recommendations are issued together with advices on research protocols which should be used to validate different cuff dimensions. Needless to say, this is useful information because use of inappropriate cuffs can cause substantial diagnostic errors, and thus, inappropriate treatment decisions in many patients. Finally, Alderman and Blumenfeld (pp. 1251–1254) remind us that antihypertensive treatment represents a successful chapter of modern medicine as the demonstration that lowering an elevated BP leads to a major reduction of cardiovascular outcomes and mortality has substantially contributed to the marked reduction of cardiovascular nonfatal and fatal events that has occurred in the last half century. According to Alderman and Blumenfeld, however, BP-lowering interventions now face a much lower potential for further protection as well as a greater risk of adverse effects. The challenge for the future is to find a way to identify and limit treatment to those who are at risk, sparing the inconveniences of unnecessary treatment to the others. That is, to move away from strategies aiming at treating the many to save the few, and implement a personalized treatment approach.
The section on BP measurements of the July issue includes one and that on risk factors five original articles. Kaul et al. (pp. 1262–1270) reports the results of a study on a large (about 19 000 individuals) Indian cohort in which BP values collected at two separate office visits showed a relatively low correlation with each other as well as with self-measured BP at home. Xie et al. (pp. 1271–1277) show that, in a cohort developing a large number of strokes (n = 2548) over a 12.5-year follow-up, BMI played an important role, the risk of a cerebrovascular event being lowest in individuals with a BMI lower than 24 kg/m2, even more if their BP was less than 130/80 mmHg. Faconti et al. (pp. 1278–1285) show that in individuals living in the UK (both Africans and whites) 24-h urinary sodium/potassium ratio was lower than in Africans living in Nigeria, reflecting a higher potassium intake in the former compared with the latter individuals. Interestingly, Nigerian people exhibited higher plasma aldosterone levels and left ventricular mass indices, indicating that the dietary differences had clinical consequences, in line with the time-honored evidence that potassium has protective effects. Bursztyn et al. (pp. 1286–1292) provide evidence from the Ohasama population in favour of an independent role of 24-h pulse pressure values for the risk of all-cause and cardiovascular mortality. Howard et al. (pp. 1293–1301) show, in a very high number of US military veterans that those involved in combat had a greater risk of developing hypertension (+26%) and that a further risk increase characterized those who were wounded (+46%). These interesting findings are discussed in the Editorial Commentary of Egan (pp. 1255–1256). Finally, He et al. (pp. 1302–1311) show that, in a sample of the Bogalusa Heart Study, 24 new metabolites (out of 1202 tested) showed a robust association with SBP and DBP values. As the study sample included both African Americans and Whites, the results are likely to apply to both races.
Three articles are devoted to organ damage, three to pregnancy and a final one to primary aldosteronism. Spronck et al. (pp. 1312–1321) show that in mice, the increase of central artery stiffness and thickness associated with aging is only modestly enhanced by the superimposition of a hypertensive state, which was obtained via infusion of angiotensin II and interference with endothelial function. Thus, in this type of experimental hypertension, aging appears to have a greater impact on aortic remodelling than chronic BP elevation. Duarte et al. (pp. 1322–13350) show that activation of toll-like receptor 7 (TLR7) is associated with a progressive BP increase, a final hypertensive state, an impairment of endothelium-dependent vasorelaxation and vascular remodelling. As this activation has been shown to accelerate lupus-like autoimmune disease, this scores in favour of the hypothesis that autoimmune mechanisms are involved in the genesis of high BP as well as that inflammation favours hypertension-related cardiovascular complications. The results of this article and their implications are discussed in the Editorial Commentary of Landry and Burger (pp. 1257–1258). Ogawa et al. (pp. 1336–1346) show that in Dahl salt-sensitive rats, exercise training attenuated renal oxidative stress, reduced renal protein excretion and decreased the production of a number of substances with potentially damaging effects on the kidney. The three articles on pregnancy deal with placental factors that may be associated with an increased risk of preeclampsia (Ueland et al., pp. 1347–1354), the prediction of the risk of preeclampsia by BP trajectories in the mid-trimester (Mi et al., pp. 1355–1366) and the modifications of echocardiographic parameters in healthy women before and after delivery, together with their possible clinical significance (Ambrozic et al., pp. 1367–1374). Lastly, Puar et al. (pp. 1375–1383) provide results on the possible advantage of a different aldosterone--potassium ratio for the diagnosis of primary aldosteronism subtypes. This is accompanied by an Editorial Commentary of Stowasser (pp. 1259–1261).
As other Journals, in the last few months, the Journal of Hypertension has received and is receiving many letters on the COVID-19 infection, which, as expected, largely focus on the possible relationship of the virus with hypertension and its treatment. An Editorial and some letters were published in the June issue of the journal. Following editorial review, other contributions are published in the current issue and will be offered space in the following ones in order to keep the readers informed on the evolving state of knowledge and opinions on this devastating infection whose epidemiological, diagnostic and therapeutic aspects are so poorly known.
Conflicts of interest
There are no conflicts of interest.