Honoring the 25^th Anniversary of the American Society of Hypertension

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This issue of the Journal of the American Society of Hypertension honors the 25^th Anniversary of the American Society of Hypertension. We begin with a historical review of the origin and early formation of the society by the current President, Henry R. Black, who provides a review of the evolution of our organization. In his remarks he emphasizes the activities of the Society to embrace not only scientists and practitioners but also to develop outreach programs and to participate in programs as advocates for patients as well as for investigators and medical personnel. He outlines the plans for future endeavors along the lines of these expanded roles.

One of the major activities of the American Society of Hypertension recently has been the solicitation and rigorous scientific vetting of American Society of Hypertension Position Papers addressing areas of rapid evolution and progress in order to inform interested individuals of the current status of recent studies in these areas. The five papers produced thus far have been published jointly in the Journal of the American Society of Hypertension and in the Journal of Clinical Hypertension. This issue reprints those that have been published to date in order to provide a handy compendium. They are listed in the chronological order in which they were published.

The first such Position Paper addresses the issue of “When and How to Use Self (Home) and Ambulatory Blood Pressure Monitoring”. The rapid and broad use of these techniques over the past several decades has provided important, and often surprising, evidence that office-measured blood pressure may not be the best reflection of true blood pressure levels over a 24 hour period nor be the most accurate predictor of blood pressure-related events.

The next paper, “Treatment of Hypertension in Patients with Diabetes” reflected the timely recognition of the increasing prevalence of obesity and diabetes in the world today, recent information regarding the impact of even minor elevations of blood glucose and hemoglobin A1c on the cardiovascular system and the kidneys, and the sensitivity of the diabetic to small increases in systolic blood pressure in terms of these events. Moreover, emerging information regarding differences in outcomes of the diabetic to treatment with different antihypertensive agents has mandated specific drug therapy as outlined in this paper.

“Hypertension in Pregnancy” rather than disappearing as a medical curiosity and challenge, has remained with us. This paper reviews the current understanding of this enigmatic problem and also summarizes the results of recent antihypertensive trials to provide guidance to the practicing physician and health-care worker encountering such patients.

“Dietary Approaches to Lower Blood Pressure” provides a cogent review of the recent intervention trials demonstrating both feasibility and efficacy of this approach. A re-reading of this important topic is very appropriate in view of two just-published articles that provide compelling evidence for the potential benefit of salt-reduction in decreasing cardiovascular events¹, ². The first of these analyses, based on recent studies, indicates that a reduction of dietary salt intake of 3 g/d from the current high levels consumed by most Americans would reduce the annual occurrence of coronary heart disease, stroke and myocardial infarction by half and all-cause mortality by one-third¹. The article further predicts an annual cost saving of between $10 and $24 Billion annually in health care costs with such a reduction in salt intake¹. The second report suggests an even larger estimate of reducing stroke and myocardial infarction by 1 million cases over the lifetime of Americans aged 45-85, and a health-care cost savings of $22-$32 billion with a relatively modest 10% reduction in dietary salt intake².

The last of the ASH Position papers “Combination Therapy in Hypertension” reviews the rationale and benefits of the plethora of combination agents which have appeared on the market over the past several decades. In view of the fact that very few hypertensives can be controlled to current goal blood pressure levels with a single drug, the increase in multiple-drug therapy and issues of patient adherence to prescribed medications makes these combinations more attractive to patients as well as to their health-care providers.

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References 

1. Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightfoot JM, Pletcher MJ, et al. Projected effect of dietary salt reduction on future cardiovascular disease. NEJM. 2010;362:590–599
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2. Smith-Spangler CM, Juusola JL, Enns EA, Owens DK, Garber AM. Population strategies to decrease sodium intake and the burden of CVD in the United States, a cost-effective analysis. Ann Intern Med. 2010;152:(publ ahead of print Mar. 1, 2010)
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