Kidney in primary aldosteronism: A key determinant of treatment outcome

Recently, it has been suggested that primary aldosteronism (PA) is associated with a variety of cardiac, vascular, metabolic, and renal sequelae that reflect the capability of elevated aldosterone to induce organ damage beyond that induced by hypertension itself. The evidence supporting of these views has been obtained from experiments conducted in rodents and clinical studies conducted in patients with this endocrine disorder. It has been suggested that untoward effects of high-salt intake are dependent on activation of mineralocorticoid receptors that might result from increased oxidative stress and changes in the intracellular redox potential. Unilateral adrenalectomy or treatment with mineralocorticoid receptor antagonists are the current options for treating an aldosterone-producing adrenal adenoma or idiopathic adrenal hyperplasia. Treatments are largely effective in correcting hypertension and hypokalemia, and currently available information on their capability to prevent deterioration of renal function indicates that surgery and medical treatment are equally beneficial in the long term. This editorial review will focus on the renal aspects of PA and highlights the role of the kidney as a key determinant of both adaptation to aldosterone-induced volume retention and response of blood pressure to treatment.

Adipose tissue in the pathophysiology of cardiovascular disease: Who is guilty?

Epidemiological evidence has shown how abdominal obesity is closely associated with the development of cardiovascular disease. It has been demonstrated that patients with extensive adipose tissue usually have other concomitant cardiovascular risk factors, such insulin resistance, hypertension and dyslipidemia. Moreover, obese patients have a significantly higher risk of developing thrombophilic events compared with the non-obese. Thus, obesity is actually considered an independent cardiovascular risk factor. The pathophysiological mechanisms responsible for the association between obesity and cardiovascular disease remain largely unknown. However, it has been postulated that obese patients have an “inflammatory milieu” responsible for their metabolic disorders and vascular disease. In this context, adipocyte-derived molecules with inflammatory activity might play a pivotal role in the development of these mechanisms. In the present report, we provide an updated overview on the molecules produced by adipose tissue that are potentially involved in cardiovascular pathophysiology.

Hypertension in children and adolescents

Pediatric hypertension (HTN) has become the focus of interest recently due to its increasing prevalence. This is mainly related to the increase in childhood obesity, although the current evidence suggests that other lifestyle factors, apart from obesity, contribute to high blood pressure (BP) in childhood. Traditionally, office BP measurements by the physician have been the cornerstone for the assessment of HTN in children. However, since the white coat and masked HTN phenomena are not rare in childhood, out-of-office BP measurements have significantly improved the accurate diagnosis of HTN and decision making. Ambulatory BP monitoring is regarded as indispensable for the evaluation of pediatric HTN, providing details not only for the staging for HTN, but also for the study of other ambulatory BP patterns. It should be pointed out that HTN in children and adolescents is associated with target-organ damage which is significant in terms of cardiovascular risk. The current knowledge, outlined in the present review, is expected to help in early and accurate diagnosis as well as in the management of HTN in children and adolescents.

Arterial hypertension, cerebrovascular diseases and dementia

Arterial hypertension (AH) is the most relevant risk factor for acute cerebrovascular disease in general. However, the prevalence of AH is not the same for the different stroke subtypes and is particularly high in lacunar infarcts and atherothrombotic stroke, low in infarcts of unusual cause and undetermined origin, and intermediate in cardioembolic stroke. This risk factor has also been related to vascular dementia and Alzheimer’s disease and their pathological manifestations (senile plaques, neurofibrillary tangles, hippocampal atrophy). The mechanisms linking AH to Alzheimer’s disease remain to be elucidated but some recent studies showed that white matter lesions seen on cerebral magnetic resonance imaging appear to be a good marker of this association. Hypertension-associated pathological changes in the brain and its vasculature include vascular remodelling and impaired cerebral autoregulation like hypoperfusion, ischemia and hypoxia, which may initiate the pathological process of Alzheimer’s disease and the expression of dementia. Therefore, prompt diagnosis and adequate control of hypertension and different vascular risk factors are the rational basis for a more effective strategy in the secondary prevention of cerebrovascular disease and dementia.

Manidipine: A different dihydropyridine

Blood pressure (BP) plays an important role in the development and progression of cardiovascular disease. Moreover, hypertensive patients often have additional cardiovascular risk factors. Despite the abundance of antihypertensive drug categories, satisfactory BP regulation is often difficult to achieve. A major cause of this difficulty to properly manage BP is the less than optimal adherence of subjects to treatment. This is often due to the various adverse effects of the antihypertensive drugs. Calcium channel blockers (CCB) have an established efficacy for reducing BP. However, their side effect of peripheral edema is often a cause for the discontinuation of treatment. Manidipine holds some unique properties differentiating it from the rest of the CCB class. It has a better safety profile with a lower incidence of peripheral edema. Moreover, there are indications that manidipine holds additional beneficial attributes, such as improvement of renal function and decrease of insulin resistance.

World Journal of Hypertension: A new bench mark in the hypertension world

This is the first issue of the World Journal of Hypertension (WJH), a bimonthly peer-reviewed, online, open-access (OA) journal. The WJH will emphasize basic and clinical research about hypertension. As the OA model provides free, full-text articles in PDF and other formats for experts and the public without registration, the WJH enhances the speed of propagation and communication of scientific research results. As Editor-in-Chief of the WJH, I and the other members of the editorial board wish to share new ideas and knowledge about basic, clinical research and epidemiology in hypertension. We believe that you will find the WJH as an important journal in which to publish your excellent works.

Genome-wide association studies of hypertension: Achievements, difficulties and strategies

Estimated from family studies, the heritability of hypertension ranges from 31% to 68%. Linkage studies and candidate gene association studies were once widely used to investigate the genetic mechanisms of hypertension. However, results from these studies could only explain 1%-2% heritability. With the technological advances and subsequently the accomplishment of the Human Genome Project, genome-wide association studies (GWA studies) have been applied to find genome-wide significant signals for many common diseases. Current GWA studies of hypertension have identified dozens of hypertension or blood pressure associated variants. However, different GWA study identified different variants and the results could hardly be replicated in other studies. Therefore, a debate took place on whether GWA studies will unlock the genetic basis of hypertension and whether we shall continue throwing millions of dollars on GWA studies. This review gives a short introduction to the history of genetic study on hypertension and summarizes the current findings for GWA studies of hypertension or blood pressure. Finally, we will discuss that debate and try to find alternative strategies and technologies that may hold a greater chance to make progress in understanding the genetic risk factors of hypertension and blood pressure regulation.