From the Editor

Article Outline

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With this issue, we begin the fourth year of JASH. The present issue provides the 2010 World Kidney Day report, four original research studies, and an ASH Position paper on combination drug therapy for hypertension.

The World Kidney Day report emphasizes the growing epidemic of obesity and type II diabetes, with its concomitant increase in renal disease, heralded initially by increased glomerular filtration, followed by microalbuminuria, and eventuating in chronic renal failure, if unrecognized and untreated. The statement is directed toward the lay public, the practitioner, and the investigator. The call is made to increase public awareness of the importance of the prevention of obesity and diabetes and public recognition of the insidious nature of renal disease associated with type II diabetes, as well as its progression to renal failure. For the health care provider, to apply these preventive strategies, to increase screening for microalbuminuria, and to implement appropriate utilization of therapeutic regimens known to modify the progression of renal impairment. For the research community, the development and assessment of new treatment approaches. These are all daunting challenges, but they must be met!

The first article in this issue is a study in Sprague-Dawley rats by Matsuura and colleagues in which they examine the effect of physical exercise on survival and vascular function in animals in whom congestive heart failure (CHF) was induced by doxorubicin administration. Exercise increased survival in this model of CHF, but there was no discernible difference in measures of nitric oxide or smooth muscle relaxation. These interesting findings suggest that either the techniques for these latter measures are insufficiently sensitive, or that other mechanisms may be responsible for the improved survival in this model of CHF.

Pereira and colleagues report observations in hypertensive humans with dilated cardiomyopathy in whom they measured coronary flow reserve as part of a longitudinal study. They found that a decrease in coronary reserve was associated with increased mortality, presumably mediated by increased left ventricular mass or decreased diastolic pressure. These findings have potentially important clinical relevance in the management of such patients. This interesting article is followed by a report on the Cardiovascular Health Study by Iyer et al, in which the investigators were able to identify the presence of systolic blood pressure >160 mm Hg and chronic kidney disease as future predictors of congestive heart failure in their cohort. These two observations have important clinical implications for cardiac function and mortality from cardiovascular disease among hypertensive subjects.

The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study in more than 19,000 participants living in the “stroke belt” by Howard and colleagues provides important new information regarding the risk of stroke. Not surprisingly, the investigators found an increased risk of stroke as blood pressure increased. However, they also noted that the age of occurrence of elevated blood pressure was an additional component of risk. Thus greater attention need be paid to even small increases in blood pressure among young individuals, and prompt and effective treatment initiated to reduce that risk. Ignoring slight increases in blood pressure among relatively young individuals cannot be condoned in view of these findings.

Gradman and colleagues have carefully prepared a new ASH Position paper regarding combination drug therapy for hypertension. This important effort is timely in view of the current recognition that as many as 75% of hypertensives will require two or more agents to achieve adequate blood pressure control. The authors have thoughtfully considered the variety of such combinations and identified those which are most useful and beneficial as well as issuing caveats regarding combinations that may not be desirable. This is a “must read” for those involved in the care of hypertensive patients.