From the Editor

Article Outline

• Copyright

This issue of the Journal of the American Society of Hypertension features several intriguing and informative reports.

The first article is a report by Dr. Townsend and colleagues of the initial meeting of the North American Artery Association held in Bethesda, MD, in April 2010. This meeting included investigators from academia and industry, medical device manufacturers, and members of the Food and Drug Administration interested in the issues involved in measurements of vascular dynamics and central as well as peripheral blood pressure. The article addresses several issues that arose during this meeting, including the possible role of central blood pressure measurements as a better predictor of cardiovascular outcomes in hypertension than the conventional brachial artery measures. The article reviews cardiovascular physiology with these differences in mind. It features descriptions of the available equipment for these measurements. A discussion of the emerging evidence for the importance of central blood pressure estimation from several recent trials provides further stimulus for future investigation.

The next article, by Professor Kario, proposes the use of combination antihypertensive therapy with a renin-angiotensin system (RAS) blocker and a calcium channel blocker (CCB) or a diuretic for high-risk hypertensive subjects with a specific focus on addressing the “non-dipper” status that such individuals often manifest. Moreover, he addresses the evidence in favor of improved benefit from combinations (such as RAS-CCB) that have a greater effect in reducing central blood pressure (also addressed by the preceding article) as well as those reducing blood pressure variability.

Jones-Burton and colleagues from the Merck Research Laboratories present their experience with an investigative renin inhibitor, MK-8141, in hypertensive humans. In the doses employed in their study, they failed to observe a significant decrease in blood pressure in comparison to placebo. Prior studies with this agent had demonstrated a seven-fold increase in immunoreactive-active renin without a decrease in plasma renin activity (PRA). Thus they postulate that a decrease in PRA is required in order to observe a significant antihypertensive effect with renin inhibitors.

Dr. DeLoach and coworkers measured endothelin-1 (ET-1) in plasma and urine in young adult hypertensive and normotensive African Americans. They observed higher plasma ET-1 in the hypertensives and also increased levels of urinary ET-1 with a glucose challenge. They suggest that ET-1 may be a biomarker of endothelial dysfunction in the peripheral, and possibly renal, vasculature in young adult hypertensive African Americans. These findings have important potential implications in the treatment of hypertension and the prevention of vascular and renal disease in this hypertensive subgroup.

Teppala et al reviewed information from more than 51,000 participants in the California Health Interview Survey using an assessment of acculturation in relation to their blood pressure status. They found a direct correlation between the level of acculturation and blood pressure. This relationship appeared to be independent of several conventional confounders. Further investigations of this intriguing relationship would seem to be important and relevant to our understanding of the process of developing hypertension.

Viera and colleagues reviewed the records of 3700 hypertensives followed in North Carolina primary care practices to identify reasons for the failure of health care providers to alter treatment regimens in uncontrolled hypertensive subjects. Issues such as poor blood pressure measurement techniques, presumption of a “White Coat effect,” the assumption that “tight” control of blood pressure is unnecessary or not beneficial, overestimation of the efficacy of single drug therapy regimens, and a reluctance to be aggressive in lowering blood pressure in the elderly for fear of precipitating an event rather than preventing one were raised by this study. Obviously, a vigorous program to address all such issues should markedly improve blood pressure control for many patients.

The final article in this issue, from Dr. Eguchi and colleagues in Dr. Kario's laboratory, examined a population of older Japanese hypertensives and found that the occurrence of silent cerebral infarction based on brain MRI was correlated with shorter sleep periods. In addition they also found gender differences in this relationship, being significant in females but not males. While the study was observational and provided no information regarding the possible pathophysiology of these findings, the findings are intriguing and bear further investigation.