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

The current issue of the American Journal of Hypertension for January 2022 begins with a review by Bock et al.1 on sleep disorders with an emphasis on sleep duration, and their impact on the regulation of blood pressure and the pathophysiology of hypertension. This is followed by Commentaries2–4 on three original papers, which will be addressed with the corresponding original manuscripts. An overactive bladder (OAB), may be a manifestation of high sympathetic activity and associate with high BP. The first original paper in the current issue of the Journal by Akbar et al.,5 reports a cross-sectional analysis of the sixth follow-up exam (2015–2016) of the Multi-Ethnic Study of Atherosclerosis (MESA) in which the authors examined the association of OAB with BP, hypertension, and BP control. Among 1,446 men and 1,628 women, OAB was present in a third of men and almost 40% of women. Among the 894 men and 981 women on antihypertensive medication, OAB was associated with lower rates of BP control among men but not women. The authors conclude that OAB may interfere with the management of hypertension in men. The next original article by Ostchega et al.,6 addresses the prevalence and hypertension control associated with urbanization in the United States, based on the 2013–2018 National Health and Nutrition Examination Survey (NHANES), and shows that among US adults, urbanization was associated with stage II hypertension. Jiao et al.7 carried out a population-based cohort study using data from the Clinical Practice Research Datalink, which included 660,545 patients with hypertension who initiated an antihypertensive drug therapy between 1998 and 2018. The authors concluded that during the study period, prescription patterns agreed with guidelines of the time, which in their view, suggests that prescribing was evidence-based. In the next paper in this issue Aparicio et al.8 report on the International Database of Central Arterial Properties for Risk Stratification (IDCARS), based on data coming from 4 continents, 13 cohorts and 10,930 individuals. According to the authors, this database will allow investigating hypotheses on central hemodynamics that could not be evaluated in individual studies. The following article is by Graham et al.,9 who in a retrospective study examined BP dynamics in the 6 months before death. The authors noted decreases in systolic BP and an increase in week-to-week BP variability in the last month before death. The latter could be the result of medication changes among other care changes as patients get closer to death. Two hundred and seven prehypertensive patients from a cohort from Cappadocia were studied with 24-hour ambulatory BP monitoring (ABPM), office BP, and home BP measurements by Özkan et al.10 These authors found that short-term BP variability predicted the development of hypertension in this prehypertensive population. Aortic dissection occurs in hypertensive patients with thoracic aortic aneurysms (TAAs). Because central BP (cBP) reflects BP in the aorta, Rooprai et al.11 evaluated the prevalence of central hypertension among TAA patients without a diagnosis of hypertension, and association of brachial BP (bBP) vs. cBP with aneurysm size and growth in 105 subjects with unoperated TAAs. Half of these subjects were not hypertensive, and 15% had central hypertension despite normal bBP. In these patients, higher cSBP and central pulse pressure were independently associated with larger aneurysm size and faster growth, whereas bBP was not. An accompanying Commentary by P. Palatini2 describes factors that increase the risk of TAA, such as heavy resistance exercise, smoking, cocaine abuse, or pregnancy, underlying that hypertension remains the main risk factor, and makes recommendations for the diagnosis, monitoring of BP including cBP, and the management of TAAs. Limitations of the study include the absence of out-of-office BP monitoring and of evaluation of visit-to-visit BP variability. Gong et al.12 investigated the role of microRNA-183, which is known to act as a tumor suppressor and is downregulated in the presence of left ventricular hypertrophy (LVH). In vitro in cultured mouse cardiomyocytes exposed to angiotensin II (Ang II), expression of miR-183 was reduced. Overexpression of miR-183 significantly diminished cardiomyocyte size and pro-hypertrophic gene expression. The authors demonstrated that T-Lymphoma Invasion And Metastasis-Inducing Protein 1 (TIAM1), a Rho guanine nucleotide exchange factor, was a direct target gene of miR-183 as shown by bioinformatics and using a luciferase reporter assay. They concluded that miR-183 may protect from cardiomyocyte hypertrophy via direct regulation of TIAM1. Guo et al.13 report in the following article on a family from China with maternally inherited hypertension with high penetrance of hypertension at an early age, in which they found the associated presence of two novel variants of mitochondrial DNA, m.15992A>G and m.15077G>A. C. Delles3 in a Commentary mentions that different strategies have been used to find genetic factors that contribute to blood pressure regulation, that already other variants in the mitochondrial genome associated with maternally inherited essential hypertension have been described, and that many of these affect genes encoding for tRNAs as in the article by Guo et al. However, these findings emphasize the complexity of hypertension and the need to continue performing careful clinical observations and meticulous workup of clinical and molecular characteristics of members of families with hypertension in order to unravel additional pathways involved in the pathophysiology of hypertension. In the final article in this issue of the Journal, Shea et al.14 describe pilot results of the Retail Outlet Health Kiosk Hypertension Trial (ROKHYT). BP had been measured at kiosks during the prior year and the intervention in the study consisted in text messages with links to educational videos related to hypertension control. The results suggest success with small significant reductions in BP in the intervention arm. Hines and Plante4 in a Commentary indicate that there is a critical need for community-based interventions to improve hypertension screening and referral for care of adults with high BP. Technologies like the ones in the ROKHYT pilot have promise to improve hypertension screening and BP control in the USA, particularly for high-risk groups like Black US adults.

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