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This final issue of JASH for 2008 contains a review article and eleven original research communications. In the lead paper, Dr. Kario Kazuomi provides an excellent and current review of information regarding the early morning surge in blood pressure (BP), its relationship to cardiovascular events and a compelling rationale for ensuring that antihypertensive regimens provide coverage of BP during this critical period. While this phenomenon has long been recognized, such a comprehensive review is very timely.

The next six papers in this issue were among those presented at the Vasoactive Peptide Symposium held in Brazil in February, 2008 and subsequently submitted, reviewed and selected for publication in JASH. Dr. Gross and colleagues from Berlin report the complex interactions of G-protein-coupled receptors in vascular responses to angiotensin II in mice and propose a potential therapeutic role for manipulation of this system. Dr. Victor Lima reports that increased vascular O-linked N-acetylglucosaminylation enhances vasoconstriction. This observation is believed to likely result from effects on eNOS expression and activity. Utilizing the knockout mouse model, Dr. Natalia Alenina examined the MAS gene and its receptor as an influence on the vascular responses to administered angiotensin 1-7. This peptide was also studied by Dr. Brosnihan and colleagues in examining salt and water balance in pregnant Sprague-Dawley rats. They provide evidence that angiotensin 1-7 influences volume expansion in pregnant rats. Ms. Giachini and colleagues studied the role of proline-rich tyrosine kinase (Pyk2) by utilizing an inhibitor of this enzyme in the DOCA-salt and angiotensin dependent models of hypertension. They observed a decrease in BP only in the DOCA-salt model when the inhibitor was used. Dr. Carneiro and colleagues studied the effects of endothelin-1 and urotensin II on rodent cavernosal responses and observed only a response to endothelin-1, suggesting specificity in the response of this muscle tissue.

These basic studies are followed by five clinically relevant papers. Dr. Daniel Lackland conducted a comparison of survival after 30 years in two similar cohorts in the state of Georgia, the Evans County population and the HDFP population. He found that both the referred care and special care groups of the HDFP study had better cardiovascular outcomes than those of the Evans County cohort after long-term follow-up. Dr. Jason Lazar conducted hemodynamic observations following water immersion in healthy adults. He observed a decreased in heart rate, no change in BP and increases in augmentation index of the aortic pressure wave. Dr. William White studied a group of hypertensives who were resistant to BP control despite treatment with three antihypertensive drugs, after addition of the aldosterone antagonist, eplerenone. The addition of this agent to the existing therapy lowered BP unrelated to the pretreatment levels of aldosterone or plasma renin activity. Moreover, the agent was well tolerated as well as being effective in reducing BP. Dr. Fadia Shaya examined the Maryland State Medicaid records to compare factors responsible for physicians prescribing dual-agent component antihypertensive therapy or fixed-dose combinations of the same agents. Despite the presumed convenience and similar cost, most physicians prescribed the dual agents rather than fixed-dose combination products. The final paper in this issue is by Dr. Black and colleagues who analyzed data from two clinical trials comparing valsartan alone or with hydrochlorothiazide in stage 2 hypertensives. They found that the age-related decrease in BP responsiveness observed with valsartan alone could be altered when the angiotensin receptor blocker was combined with the diuretic, whereas in younger subjects the response to valsartan alone was greater than in the older subjects. These observations are consistent with similar findings made with angiotensin converting enzyme inhibitors almost 25 years ago in African-American hypertensives.¹

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Reference 

1. Weinberger MH. Blood pressure and metabolic responses to hydrochlorothiazide, captopril and the combination in black and white mild-to-moderate hypertensive patients. J Cardiovasc Pharmacol. 1985;7:S52–S55
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