From the Editor

Article Outline

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This issue of JASH begins with the final accepted paper from the Vasoactive Peptide Symposium held in Brazil in February, 2008 by Ms. Wynne and her colleagues, Drs. Chiao and Webb. They provide a detailed review of the signaling mechanisms for the vascular smooth muscle responses to angiotensin II and endothelin-1. This review provides comprehensive insight into the contractile effects of these peptides.

This is followed by a review by the ASH Young Scholar Awardee, Dr. Prieto-Carrasquero and colleagues detailing their studies with the intrarenal renin-angiotensin system. Their observations suggest inappropriate activation of renin in distal nephron segments with the resultant increase in the activity of the subsequent cascade of peptides.

Drs. Hollenberg, Fisher, and McCullough provide a fascinating narrative of studies of the Kuna Indians in the San Blas Islands of Panama and how the search for a genetic basis for their apparent resistance to hypertension and cardiovascular disease led to the identification of a novel dietary component influencing blood pressure (BP). They discovered that the pragmatic and habitual consumption of flavanol-rich cocoa could explain this beneficial biological effect in contrast to a genetic etiology. They also provide evidence that such consumption could be expected to produce a vasodilatory effect by increasing nitric oxide synthase activity, a plausible explanation for the observations of both BP and cardiovascular events.

Dr. William Stason provides a 30 plus year perspective on the cost-effectiveness of treating hypertension. In doing so, he considers the shift in emphasis from diastolic to systolic pressure as the primary BP target and how this impacts on such analyses. The evolution of more expensive medications and the issue of concomitant disorders are also discussed as they impact on cost-effectiveness in the treatment of hypertension.

Dr. Friedrich Luft provides a historical perspective on the discovery of new peptide hormones related to BP as an introduction to, and caution concerning, the following report of a novel protein, “cortexin”, by Dr. Chakraborty and his colleagues. They provide evidence for an antihypertensive hormone from the renal cortex which they believe acts as an activator of nitric oxide synthase. They report the development of a measurement system for this protein and the finding of a deficiency in the substance in hypertensive humans. This very preliminary finding will obviously require confirmation, extensive biochemical and physiological verification and further study.

Yu and associates report a well-documented case report of an individual sustaining arrhythmias and cardiomyopathy apparently resulting from activating autoantibodies to beta-adrenergic and muscarinic receptors. This individual case joins many others in which this unusual pathophysiology has been identified. The documentation is exceptional.

The final research study by Tziolas and colleagues examined normotensive offspring of known parental BP levels for evidence of an association with BP and insulin resistance among the Greek population. They observed a correlation between the BP of offspring and the parental BP pattern and found that insulin resistance was not related to parental BP but rather to body mass index. These observations provide additional evidence regarding the nature-versus-nurture aspects of BP and metabolic alterations.

In addition, we are pleased to publish another of the Position Papers from the ASH Writing Group on the treatment of BP in diabetes by Drs. Bakris and Sowers. This update incorporates the strategies resulting from several recent trials which will be of relevance and interest to all who see such patients.