This issue of JASH begins with a review of an often-neglected topics, the relationship of alcohol consumption and blood pressure (BP), by Drs. Klatsky and Gunderson. Extensive information is presented regarding the dose-relationship, beverage type, effects of withdrawal and even the contributions of alcohol intake, BP to specific cardiovascular events. The information provided should be of considerable benefit to clinicians in counseling their patients.
The next five papers were submitted for peer-review by authors presenting at a recent Symposium on Vasoactive Peptides held in Brazil this past winter. Drs. Gutkowska and Jankowski present extensive data documenting the role of oxytocin receptors on cardiovascular tissues and demonstrate mechanistic relationships relevant to cardiovascular effects. These findings make it appropriate to examine the role of this peptide further in future research studies.
Dr. Abrão Saad and colleagues conducted studies of the mediation of the effects of angiotensin II injection in the sub-fornical organ and observed a dual action of both nitric oxide and the L-type calcium channel in the pressor response. Dr. Atsuhiro and colleagues provide evidence that the pro-renin receptor is involved in the nephropathy associated with experimental type II diabetes mellitus. These findings extend their earlier studies in streptozotocin-induced diabetes to the db/db mouse model of type II diabetes. The organizer of the Vasoactive Peptide Symposium, Dr. Robson Santos and his colleagues report on the role of angiotensin 1-7 in the changes in extracellular matrix and components of the renin-angiotensin system in experimental cardiac hypertrophy. The final paper from the symposium included in this issue is from Dr. Kobori and colleagues, who extended their earlier findings in experimental animals to humans with renal disease. They were able to correlate their observations of urinary angiotensinogen with the severity of human renal disease. These interesting findings, when confirmed, may provide an important area of future inquiry.
Dr. Hebert and colleagues have revisited the long-standing concern regarding the lack of evidence that antihypertensive treatment with thiazide diuretics can be shown to reduce coronary artery disease and sudden cardiac death in long-term trials. They conducted an extensive meta-analysis of studies which combined epithelial sodium channel inhibitors with thiazides and observed a significant reduction in both coronary mortality and sudden cardiac death. These findings are very compelling and have immense implications for the treatment of hypertension, particularly in view of the forthcoming JNC VIII document that is currently in preparation.
Dr. Coly and colleagues report on a self-administered questionnaire among inner-city subjects in Milwaukee, Wisconsin beginning in 1994. They measured a variety of factors in an attempt to ferret out those responsible for poor hypertension control. They found that not taking antihypertensive therapy rather than inadequate therapy was a major factor. Poor drug adherence has long been known to be an important reason for poor BP control but the causes of such have evaded effective resolution. It is hoped that these results will re-focus attention on this difficult issue.
Dr. Protogerou and colleagues examined elderly hypertensives by measuring vascular stiffness via pulse wave velocity in relationship to orthostatic BP changes. They found an inverse relationship among untreated hypertensives that was not seen in the treated subjects. These findings obviously have important implications for the identification and treatment of orthostatic hypertension in the elderly.
Dr. William White conducted a comparison of extended-release metoprolol succinate with amlodipine in stage 1 and 2 hypertensives and observed greater reduction in rate-pressure product (heart rate x BP) and lower early morning BP levels with the beta-blocker. The reduction in rate-pressor product would be expected with a beta-blocker compared to a non-rate reducing calcium channel blocker. However, the lower early-morning BP could be important in avoiding or minimizing the risk of the rapid increase in events seen with the early morning rise in pressure.
The final paper in this issue is by Dr. Evelyn Chiao and colleagues and addresses community-based, real-world issues in hypertension control. A variety of factors offer many different approaches to this issue which, sadly, remains with us after many years of multi-pronged approaches to improved detection and treatment of this pandemic disorder.
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