From the Editor

This issue inaugurates the third year of the Journal of the American Society of Hypertension (JASH). In the first article, Dr. Yoshida and his colleagues examined the role of angiotensin receptor blockade with valsartan compared to treatment with hydralazine in the fructose-fed rat model of diabetes for insight into the mechanism of glucose utilization. They observed improved glucose uptake in the valsartan-treated animals but not in those receiving hydralazine, supporting a role for the renin-angiotensin system in this model.

Dr. de Bold examined the role of potassium channels in the release of atrial natriuretic factor (ANF) in his studies presented at the Vasoactive Peptide Symposium in Brazil last February. Utilizing agents known to activate or block potassium channel activity he found that activation was associated with increased ANF release while inhibitors of such activity reduced ANF. The broad range of clinically used and experimental agents studied has great clinical relevance.

Drs. Kronborg, Hallas, and Jacobsen surveyed almost 8,000 adults in Denmark to define the prevalence, awareness and treatment of hypertension. They found almost 26% were hypertensive, 72% were aware and 64% were being treated of whom 57% were under control by office measurements. These data replicate the findings in the United States to a close degree.

Dr. Gaillard and colleagues surveyed non-diabetic, obese African-American females to assess the relationships between blood pressure (BP) and components of the metabolic syndrome. They found that elevated BP was significantly associated with components of the metabolic while subjects with normal BP were relatively free of such findings. It will be interesting to re-examine these subjects after the passage of time to determine if subsequent increases in BP among those deemed normotensive at this initial evaluation is associated with deterioration in other metabolic syndrome components.

The study by Dr. Axon and colleagues is a sophisticated evaluation of hypertensive patients to determine how their perception of the future risks of elevated BP impact on their personal actions to reduce their BP via home BP monitoring, diet, exercise, adherence to prescribed medications and other similar behaviors. This study demonstrates that the individual's perception of risk does indeed impact on these activities. The development of interventional techniques to improve these behaviors is anticipated.

Dr. Aparicio and colleagues from the Mayo Clinic address an important clinical issue. The widespread use of percutaneous angioplasty in hypertensive patients with renal arterial lesions has had a very disappointing outcome with infrequent cure of hypertension and often resulting in worsening of renal function. Obviously not all renal artery lesions are responsible for the hypertension and thus, functional assessment may provide a better way of identifying those most likely to benefit from intervention. The article reviews and assesses the various noninvasive techniques used for the differentiation of renal artery stenosis from renal vascular hypertension.

Drs. Gaddam and Oparil provide a very thoughtful review of the treatment of congestive heart failure with preserved ejection fraction, that associated with diastolic dysfunction. A detailed discussion of the various cellular and biochemical abnormalities associated with this condition has led to a proposed therapeutic approach, currently under study. The results of this clinical trial and others like it in such patients are eagerly awaited. This is particularly true in view of the just-reported study with irbesartan that failed to demonstrate benefit in a similar population.1

The final paper in this issue is an excellent example of translational science in hypertension. Dr. Bisognano and colleagues review the basic science background of the role of the baroreceptor reflex in BP control and its clinical application via the development and testing of a device which stimulates this receptor in animals and now, in severely hypertensive humans as well. While the investigation of such such a novel approach to the treatment of resistant hypertension is just beginning and we have much to learn about this approach, it provides a potentially important addition to our armamentarium in such patients. Further reports will be eagerly awaited.