From the Editor-in-Chief: Issue at a Glance

The present issue of the American Journal of Hypertension for June 2021 begins with an opinion article by Elias et al.1 regarding opportunistic blood pressure screening on dental appointments and risks of automated wrist-cuff devices used on those occasions. The authors point out that guideline-directed recommendations for accurate BP measurement are often not followed when office blood pressure screening is performed in the dental office. The reasons are increasing use of automated wrist-cuff devices and blood pressure screening performed on subjects seated in the dental chair. The authors are of the opinion that the automated arm-cuff method should be used, and that subjects should be properly seated at a table with blood pressure measurement conducted following the recommendations of the American Heart Association. The following article by Wang and Lloyd-Jones2 is a review on cardiovascular risk assessment in hypertensive patients. The authors describe the prognostic significance of levels of blood pressure, cardiovascular risk prediction equations and the rationale for evaluating global risk in hypertensive individuals. They review several biomarkers that refine risk assessment in some patients. The authors conclude that there is potential population benefit when current cardiovascular risk prediction is incorporated into hypertension management. Wang and Lloyd-Jones argue however that treatment does not return an individual to the cardiovascular risk of someone who has never developed hypertension, which underlines the need for primary prevention. Four Commentaries follow, one by Angeli et al.3 on masked nocturnal hypertension; one by C. Iyengar and Ram4 on risk associated with concentric vs. eccentric left ventricular hypertrophy; another by Undurti N. Das5 on genes, genetic polymorphisms, diet, soluble mediators, and their role in the pathophysiology of type 2 diabetes mellitus and hypertension; and finally, a fourth one by Jerzy Beltowski,6 on salt intake, aldosterone secretion, and obesity, and their role in the pathogenesis of resistant hypertension. The first original article is by Foti et al.,7 and it presents data on changes in hypertension control in a community-based population of older adults between the years 2011–2013 to 2016–2017 from the Atherosclerosis Risk in Communities (ARIC) Study. The study demonstrated that BP control decreased among white and Black older adults. At follow-up Black individuals with diabetes or chronic kidney disease were less likely to have controlled blood pressure. The authors wonder whether higher treatment goals may have contributed to these findings, including differences by race. In the next original article Dudenbostel et al.8 present the finding that levels of urinary aldosterone are increased paradoxically on a high salt diet in obese resistant hypertensive patients. Plasma levels of aldosterone correlate with body mass index. However, the authors had expected that aldosterone levels would decrease on a high sodium diet in agreement with the suppression of aldosterone secretion associated with fluid retention induced by the higher dietary sodium intake. The authors conclude that there may be a dysregulation of aldosterone secretion in obese patients in the presence of elevated salt in the diet. The article is accompanied by a Commentary by Jerzy Beltowski6 that discusses mechanisms that can explain these findings, and suggests that they may contribute to both resistant hypertension and target organ damage. As well, they suggest the importance of a low sodium diet and the use of mineralocorticoid receptor blockers in overweight or obese hypertensive patients. In the following paper in this issue of the Journal, Narita et al.9 examined the seasonal variation of blood pressure measured by a home device in the nationwide, practice-based Japan Morning Surge-Home BP (J-HOP) Nocturnal BP study. They provide evidence that the prevalence of masked nocturnal hypertension is higher in the summer than in other seasons. They also indicate that the difference was clinically relevant. The article is accompanied by a Commentary by Angeli et al.3 that discusses the high prevalence of masked hypertension and the cardiovascular risk associated with this unfavorable condition. The authors of the Commentary point out limitations to this study, as well as the fact that masked nocturnal hypertension can be correctly diagnosed only by ABPM, and that comparative studies are necessary to determine if masked nocturnal hypertension can be reliably diagnosed using other approaches. The next article by Guzik et al.10 reports echocardiographic and hemodynamic parameters in 690 hypertensive subjects. The authors evaluated concentric and eccentric remodeling of the heart in these patients, and their association with long term cardiovascular outcomes over 10 years. Concentric hypertrophy was associated with worse outcomes than eccentric hypertrophy in hypertensive subjects, and in the case of concentric left ventricular hypertrophy, relative wall thickness predicted risk of all-cause mortality. Blood pressure variability also showed significant predictive value for major adverse cardiac and cerebrovascular events and all-cause mortality. In an accompanying Commentary, Iyengar and Ram4 suggest that it is not evident whether cardiac geometry provides incremental value beyond blood pressure control in hypertension, and conclude that it is critically important to control hypertension in all subjects whatever the left ventricular hypertrophy phenotype. It is well known that obesity contributes to elevation of blood pressure. Fundora et al.11 examine in the next paper in this issue of the Journal the correlation in children of oscillometric measurements of blood pressure with invasive measurements, and whether obesity results in worse correlation between methods than in non-obese children. The authors found that simultaneous blood pressure measurement by oscillometric versus intra-arterial approach showed low correlation between both methods both in obese and non-obese children. Healthcare providers need to be aware of this shortcoming of oscillometric blood pressure measurements in children. In the following paper, Varadarajan et al.12 report on the association of longitudinal changes in NT-proBNP with changes in left atrial volume and function in 1,838 participants from the Multi-Ethnic Study of Atherosclerosis cohort who underwent cardiac magnetic resonance imaging and measurement of NT-proBNP plasma levels at baseline and at 10-year examinations, and who did not develop heart failure, myocardial infarction, and/or atrial fibrillation in this period. Their results demonstrate elevated levels of intracardiac stress assessed by NT-proBNP plasma levels are associated over the long term with left atrial remodeling. Dowlati et al.13 in the current issue investigated whether increased pulse pressure variability within the first 24 hours of a subarachnoid hemorrhage leads to poor disposition of patients. In a retrospective study of 174 patients who suffered an aneurysmal subarachnoid hemorrhage, increased blood pressure and pulse pressure variability within the first 24 hours of admission predicted a poor discharge disposition. The last article in this issue is by Cheng et al.,14 and it identifies a 14-single nucleotide polymorphism (SNP) cumulative weighted genetic risk score associated with hypertension in patients of Han Chinese descent in Taiwan among 999 type 2 diabetes subjects (cohort 1) for the first genome scan stage, and 922 type 2 diabetes subjects (cohort 2) for the replication stage. A very detailed Commentary by Undurti N. Das5 accompanies the paper of Cheng et al. analyzing the role of genes, genetic polymorphisms, different mediators and interactions with the diet that participate in the pathophysiology of type 2 diabetes and hypertension and their frequent association.

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