From the Editor

Article Outline

• Copyright

This issue of JASH begins with a review by Dr. Satyavan Sharma of the alarming incidence of hypertension, diabetes, metabolic syndrome and cardiovascular disease among the population of South East Asia. The rapid progress in economic development and industrialization in this area has brought with it a dramatic increase in these disorders. A recent study in an Indian population disclosed an average dietary salt intake of 8.5 g/d, much higher than current recommendations by most health organizations. In addition, it appears that the inhabitants of these countries demonstrate greater fat deposition at the same body mass index than individuals residing elsewhere. This may account for the epidemic of metabolic syndrome and diabetes mellitus currently being observed. Furthermore, increases in body mass and particularly in the rate of childhood obesity have also been implicated in these observations and bode poorly for the future unless effective life-style alterations can be achieved.

Dr. Robert Rosenson provides a review of the role of statin-induced lipid reduction in primary and secondary stroke prevention. The focus of this article is on the hypertensive individual and surveys the results of several recent trials to provide compelling evidence of the benefit of such treatment.

Following this, Dr. Stanley Franklin provides evidence that vascular stiffness is a predictor of cardiovascular disease. While pulse pressure was originally emphasized as a measure of vascular stiffness, more sophisticated techniques of pulse wave velocity and vascular wave amplification have now been validated as more sensitive measures of stiffness. Moreover, these techniques have now moved from the research laboratory to the bedside and office and are available to the clinician seeking more information regarding vascular function.

Dr. Chen and colleagues from the long-running and very informative Bogalusa Study provides evidence from young adults of racial differences in the relationship between heart rate and pulse wave velocity, a surrogate for vascular thickening. The importance of these pre-morbid observations from Bogalusa, beginning in childhood and following to adulthood and eventually, cardiovascular disease, cannot be overestimated. They have consistently identified racial differences in many important risk factors for cardiovascular disease and have consistently served as reminders that the antecedents of cardiovascular disease have their roots in childhood and adolescence.

Professor Tsiofis and co-workers examined left ventricular function in hypertensives with an exaggerated blood pressure (BP) response to standard exercise in comparison with hypertensives with a lesser exercise-related rise in pressure. They found evidence of greater left ventricular diastolic dysfunction in the former subgroup. It will be interesting to observe whether vigorous antihypertensive therapy or treatment with specific antihypertensive agents can modify these structural abnormalities which have been linked to an increased risk for congestive heart failure and other cardiovascular disorders. Indeed, in the following research study by Professor Smith and colleagues, utilizing vascular biopsies in humans after treatment with an angiotensin-receptor blocker (olmesartan) or a beta-adrenergic blocker (atenolol), a differential effect of these agents on vascular structure was noted despite similar BP reduction. It would be of interest to know whether similar differences in cardiac structure and/or function could also be identified in such individuals.

The role of vascular cytokines was the subject of the research studies in the final two articles of this issue. Professor Paletas and colleagues examined a component of the complex relationship between angiotensin II (Ang II) and atherosclerosis by studying the effects of Ang II on human monocytes, a major cellular component of atheroma formation. They observed that Ang IIactivates the Na+/H+ exchanger (NHE) in monocytes as reflected by an increase in cellular pHi which was prevented when an inhibitor of NHE was present. Thus, another step in the Ang II-induced atheromatous process has been delineated. It is also known that Ang II enhances endothelin (ET) production. Endothelin's effects on vascular tone and BP in obese and diabetic humans were the subject of the last article in this issue. Dr. Yoon and associates used an antagonist of the ET-A receptor, BQ 123 to study volunteer subjects and concluded that vascular tone, but not BP, was influenced by this receptor.

I wish to call all readers attention to the two very important papers on home and ambulatory blood pressure monitoring that appears in this issue. These timely statements, carrying the weight of the major organizations devoted to hypertension and cardiovascular diseases, will likely impact the health of Americans for decades to come.