From the Editor

With this issue, we complete Volume 1 of the Journal of the American Society of Hypertension. The challenges in beginning a new journal have been formidable and the satisfaction derived from the efforts involved have made it all worthwhile. I should emphasize that the success of JASH has been due to the concerted efforts of the authors, Associate Editors, Reviewers, and our conscientious Managing Editor, Amy Mason. In this issue, you will find a listing of the contributors to the entire first volume as well as of the reviewers whose critical and helpful insights were most valuable in guiding the authors and the editors.

This issue features two review articles from the authors of invited lectures at the Plenary Sessions of the most recent American Society of Hypertension Annual Scientific Meeting. Interestingly, both deal with different aspects of diuretic therapy in hypertension. Dr. Barry Materson, Secretary of the American Society of Hypertension, provides an enlightening historical review of the use of diuretics in the treatment of hypertension. Proceeding from the era of “mega-dose” therapy to the evolution of low-dose diuretic treatment, both as monotherapy and in combination with other agents, he reviews the major trials that have established diuretics as a major component of current regimens. In Dr. Materson’s review, a brief discussion of the metabolic side effects of diuretic therapy sets the stage for the second review paper, authored by Drs. Biff Palmer and Amir Naderi in which these alterations are described in elegant detail. The paper establishes the physiological and pharmacological rationale for the use of diuretics, grouped by type, and duration of action. The effect of dose as well as site and duration of action are reviewed along with strategies for avoiding or minimizing the adverse effects. As the author of the first paper to recognize that many of these adverse metabolic effects of diuretics can be blunted or prevented by blockade of the renin-angiotensin-aldosterone system,1 it is gratifying to see the evolution of this concept some 25 years later. Perhaps, differences in doses of agents used or their duration of action can explain the inconsistency with which these benefits have been observed among the many agents that act by interrupting this systemic cascade.

The original research contributions in this issue span a broad area of investigation. Strand and associates performed a 20-year follow-up of initially normotensive Norwegian males and found that their baseline hematocrit predicted the subsequent development of hypertension. The authors speculate concerning the possible mechanism(s) that may be related to these findings and suggest that a long-neglected area of hemodynamics, namely rheology, may be worthy of further exploration.

Ratto and colleagues examined untreated hypertensive participants in the MAGIC trial with measurements of high-sensitivity CRP and estimates of target-organ damage (left ventricular mass, proteinuria and carotid atherosclerosis) and found a significant correlation, even after adjustment for other potentially confounding factors. They conclude that inflammatory mechanisms are involved in the end-organ effects often observed in untreated hypertensive subjects. Gadegbeku and associates studied insulin action by measuring non-esterified fatty acids in response to a hyperinsulinemic euglycemic clamp in a small group of non-diabetic chronic kidney disease (CKD) patients in comparison to non-diabetic hypertensive and normotensive subjects with normal renal function. They found an impairment of insulin action in the hypertensive group but not in the CKD or normal subjects.

A study from Dr. James Sower’s group utilizing the transgenic rat model that overexpresses the renin gene examined the effect of exercise training on cardiac function in this model with increased tissue angiotensin II levels. They found that exercise training at a young age led to preserved cardiac index in the face of diastolic dysfunction.

The final report in this issue was a study conducted by Dr. Zhou and colleagues in Dr. Catanzaro’s group, examining the effect of an angiotensin converting enzyme inhibitor, and angiotensin II receptor blocker and the combination on blood pressure and stroke occurrence in stroke-prone spontaneously hypertensive rats. They found that combination therapy was the most effective at reducing both blood pressure and stroke occurrence in these animals. Their findings provide experimental support for the use of combination therapy when additional blood pressure reduction and end-organ protection are desired.