The 22nd Annual Scientific Meeting and Exposition of the American Society of Hypertension, Inc. has just concluded and provided one of the most diverse and stimulating opportunities for the discussion of exciting new information related to hypertension, vascular disease, and health care. Many of the most informative presentations, including both state-of-the-art reviews and original research papers, will be published in future issues of JASH in order to provide valuable insights for those who were not able to attend a particular session or the meeting.
This fourth issue of JASH features an up-to-date review of the relationship between leptin and the vasculature, a topic of increasing interest and relevance at this time of epidemic obesity and its cardiovascular sequelae. Issues requiring further investigation in this area are also emphasized. Campese and Ye extends their interest in the mechanisms involved in the hypertension resulting from renal sympathetic nervous system activation by presenting observations in the phenol-treated rat model. They found that an antioxidant, vitamin E, blunted the rise in blood pressure and the central nervous system effects of increased sympathetic activation, suggesting yet another possible role for antioxidants in general, and vitamin E specifically, in preventing cardiovascular and renal disease.
Shinshi and colleagues have further explored the mechanism by which angiotensin receptor blockade may improve glucose metabolism by studying the fructose-fed rat model. They observed that Ang II receptor blockade (ARB) administration improved glucose uptake mediated via an AMP-activated protein kinase pathway. Verma and colleagues provided important new clinical information regarding ARBs by surveying the incidence of acute coronary syndrome (ACS) in a database of 1.4 million elderly Canadians receiving treatment with either an angiotensin converting enzyme (ACE) inhibitor or an ARB. They found a similar reduction in the occurrence of ACS in both groups further suggesting that ARBs may have the same beneficial outcome in reducing the manifestations of coronary disease as has been attributed to ACE inhibitors.
While it has long been recognized that there is a relationship between sleep-disordered breathing patterns and blood pressure, Investigators at the National Institute of Aging have provided an interesting and novel observation that daytime respiratory rate may be associated with sodium sensitivity of blood pressure in women. These findings deserve further investigation and scrutiny in terms of potential mechanisms and treatments. A pooled analysis of studies involving some 7000 hypertensive patients with the new direct renin inhibitor, aliskeren, has provided additional important information about this agent. Efficacy in blood pressure reduction was demonstrated in hypertensive subjects that was independent of age, gender or ethnic background with aliskeren alone in comparison to placebo and in combination with diuretic, ACE inhibitor or calcium channel blocking agents. Moreover, the incidence of adverse effects with this novel agent was similar to that observed with placebo. This information will be useful to the healthcare provider in the positioning of this new antihypertensive agent.
The final paper in this issue addresses the impact of guideline exposure of treating physicians in influencing achievement of blood pressure goals among their hypertensive patients. This is of particular importance in those individuals at highest risk for cardiovascular events, especially diabetics. These findings bear confirmation and justify reiteration and repetition of the current goals for blood pressure reduction in an effort to extend the benefits of blood pressure control to high-risk individuals.
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