From the Editor

Article Outline

• Copyright

I hope that you found the 25th Anniversary ASH meeting as stimulating and informative as I did and as all of the attendees with whom I spoke acknowledged. Moreover, it was reassuring to see such a great turnout at the meeting in view of current economic issues.

This issue of JASH contains several special articles that I am sure will be of interest to you. It begins with a description of ASH's 3-year response to the commitment to public education and service exemplified by the ASH Community Outreach Program by the Chair of the effort, Dr. Keith Ferdinand. This incredibly successful and rewarding program began in New Orleans, Louisiana, in conjunction with the ASH annual meeting in 2008, on the heels of the devastation wrought by Katrina. This effort, of which everyone can be very proud, was continued at the 2009 meeting in San Francisco and the recent New York City meeting. It is a splendid example of how voluntary efforts on the part of professionals, ASH staff, and volunteers from the community can impact public awareness and treatment of hypertension.

Dr. Peter Feig and colleagues have prepared an extensive and informative description of the processes involved in bringing an antihypertensive drug from inception to market. This article provides insight into many aspects of the perilous and expensive journey that must be taken and why so many molecules are discarded before success is achieved. The global aspect of hypertension and cardiovascular disease, an aging population, cost, and safety concerns all influence drug development in ways that were not generally appreciated in decades past. The burgeoning genetic information explosion also will impact the future of antihypertensive therapy in ways not fully understood today.

Dr. Nagai and colleagues have prepared an elegant review of the elaborate connections between the insular cortex of the brain and blood pressure and cardiovascular function. Although the relationships between cerebral function and the cardiovascular system have been long appreciated, this particular aspect is emerging with increasing importance. This review is useful in the context of new knowledge and to provide a fruitful substrate for new research efforts.

Although the measurement of blood pressure has long been considered routine, information from the past few decades has called attention to the patterns of blood pressure variation. Nondipping and blood pressure variability itself have now been shown to impact end-organ damage and cardiovascular events. Dr. Friedrich Luft reviews the background of these patterns and their scrutiny as a prelude to two important original research papers that follow. In the first of these, by Dr. Veerabhadrappa et al, a correlation was found between blood pressure variability and a biomarker of inflammation, high-sensitivity C-reactive protein, in a group of high-risk African American hypertensives. Although a direct causal relationship cannot be inferred from this small study, it provides additional evidence for a relationship between the two leading to cardiovascular damage and events. The second original research paper by Drs. Afsar and Elsurer demonstrated a correlation between nondipping in hypertensive subjects and another marker of end-organ disease, urinary albumin excretion. Because the latter has been shown to be an independent risk factor for coronary artery disease, this provides additional evidence that this abnormal blood pressure pattern (nondipping) identifies high-risk individuals.

The final original research article in this issue, by Dr. Simova and colleagues, adds abnormal flow-mediated vasodilation as a predictor of coronary artery disease in addition to stress electrocardiography. Although it is not surprising to learn that different abnormalities of vascular responsiveness are related to the likelihood of cardiovascular events, this new information provides a quantitative addition to our predictive clinical models.