This issue of JASH begins with an editorial commentary on the role of inhibitors of the renin-angiotensin system (RAS) in diabetes mellitus by Dr. George Bakris. This is of great and timely current interest in view of a recent publication of the benefit of RAS inhibition in the prevention of retinopathy in type I diabetes without an apparent benefit in reduction in proteinuria. This cogent discussion delineates some of the pathophysiological mechanisms involved in both forms of diabetes as a possible explanation for the confusing findings and provides some useful therapeutic inferences.
Dr. Barry Materson and Ms. Bernal provide an up-to-date review of the recent literature examining the effects of ethnicity and blood pressure response to antihypertensive therapy. While this article does not add new information to this area, it does provide a concise and well-reasoned review of the topic for interested clinicians. We anticipate further contributions to the literature on this topic very soon.
Drs. Javeshghani and colleagues examined an animal model of menopausal estrogen deficiency and hypertension, the FORKO rat, in terms of vascular responses. They documented altered vasorelaxation and endothelial dysfunction in these animals that was aggravated by a high-fat diet regimen. These findings provide information worthy of further investigations in human subjects.
Drs. Lin, Phillips, and Manning studied Dahl salt-sensitive rats subjected to high sodium intake with and without an angiotensin receptor blocker (ARB). They observed that RAS inhibition with an ARB prevented or reduced the intrarenal damage associated with angiotensin II during the high sodium intake. These findings have potentially important implications for human hypertensives during a high sodium intake and provide further evidence for the beneficial effects of RAS inhibition.
Drs. Splenser, Fisher, Danser, and Hollenberg studied the effect of yet another approach to inhibition of the RAS in normal human subjects, that of direct renin inhibition with aliskeren. The subjects were studied after a low sodium diet which raised renin levels above what would be anticipated during a “normal” sodium intake. They observed a marked rise in renal plasma flow and a less-vigorous increase in glomerular filtration rate. Moreover, they observed a correlation between these measures of renal function. These findings provide further information regarding the activity of the RAS and its inhibition upon renal function in humans.
The latest ASH Position Paper on Dietary Approaches to Treat Hypertension that has been prepared by Dr. Lawrence Appel. It should be of interest and utility to everyone interested in the treatment and prevention of hypertension.
The final article in this issue by Drs. Brook and Rajagopalan review an area of new concern, that of the relationship to particulate matter in the air and endothelial function and blood pressure in both humans and animals. I suspect that this information will provide the substrate for many important and relevant new studies.
FULL TEXT