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

The current issue of the American Journal of Hypertension for February 2021 begins with 3 reviews. The first one by Idiaquez et al.1 is on neurogenic orthostatic hypotension and the lessons learned from synucleinopathies, neurodegenerative disorders caused by abnormal α-synuclein deposits such as multiple system atrophy, Parkinson’s disease, Lewy body dementia, and pure autonomic failure. They review the pathophysiology and goals of treatment of neurogenic orthostatic hypotension emphasizing that improvement of quality of life and preventing syncope and falls are the main objectives of management. The second review in this issue is on challenges in hypertension associated with erectile dysfunction.2 Almeida de Oliveira and Pedrosa Nunes discuss the role of vasoconstrictors and vasodilators, and how these affect vascular and erectile structures. Enhanced oxidative stress and the innate immune system, the latter via Toll-like receptor 4, contribute to a low-grade inflammatory state that favor both hypertension and erectile dysfunction. The role of innate immune mechanisms of arterial hypertension and autoimmune disease is reviewed by Jung et al.3 The authors discuss how innate immune cells participate in the development and maintenance of elevated blood pressure. They also address the association of hypertension with autoimmune diseases, and how the understanding derived from the latter provides insights to the role of the immune system in cardiovascular disease and hypertension. Following the 3 reviews we have in this issue a short communication derived from the Dietary Approaches to Stop Hypertension (DASH)-Sodium trial regarding the relationship of uromodulin in urine and blood pressure.4 Based on the effect of uromodulin on the sodium-potassium 2-chloride transporter in the thick ascending limb of the loop of Henle, the effect of its overexpression in mice and the genetic relationships that has been established between uromodulin and hypertension, Bakhoum et al. used data from subjects randomized to the control diet of the DASH-Sodium trial who were assigned to a low, medium, and high salt diet in random order. Higher urine uromodulin levels, however, were not associated with greater increase in blood pressure in response to the higher salt intake, suggesting that uromodulin does not contribute to sodium-triggered blood pressure elevation. The study by Ringrose et al.5 in the current issue analyzed that effect of ambient temperature on simulator-derived oscillometric blood pressure measurements since these instruments may be used in countries with higher ambient temperatures than those that the instruments are certified for. They used a custom heat chamber that heated each device to the specified temperature and found that higher ambient temperatures resulted in oscillometric blood pressure measurements that were comparable to those performed at room temperature. This provides reassurance that these instruments may be used in countries with very hot climate without loss of accuracy. Cai et al.6 examined in this issue central hemodynamic indices in children to assess the accuracy of current techniques compared with invasive intra-aortic measurements in 29 children undergoing cardiac catheterization. They conclude that the currently available radial adult transfer function accurately estimates central systolic blood pressure with invasive pulse pressure calibration, while age-appropriate transfer functions do not appear to provide additional benefit. It is well known that the association of metabolic syndrome (MetS) and hypertension increases cardiovascular morbidity and mortality. Aghajani Nargesi et al.7 report in the current issue their study of pigs with renovascular hypertension with diet-induced MetS in which they expected to induce myocardial mitochondrial damage and cardiac injury. They examined cardiac mitochondrial morphology and myocardial function and found indeed evidence of myocardial mitochondrial damage and dysfunction, cardiac remodeling, fibrosis, and diastolic dysfunction. Mitochondrial injury and impaired mitophagy may be important mechanisms and could represent targets for therapy of cardiac injury in patients with coexisting MetS and hypertension. Li et al. have performed a cross-sectional study on aging and adult health (SAGE) across 8 provinces in China. They now report on a subsample of 7,403 subjects aged 60 years or more, 66% of whom had hypertension and 36% of whom had an associated comorbidity.8 Prevalence of hypertension and the number of comorbidities increased with age. Although the prevalence of multiple comorbidities was higher among urban subjects, these reported better health status, whatever the number of associated comorbidities. The authors conclude that health promotion policies targeting older people should be developed especially for rural areas to reduce health disparities between rural and urban elderly patients with hypertension. The relationship between smoking and hypertension is not well defined. Data from a 6-year follow-up study of US Hispanic adults were used by Kaplan et al. to examine the dose–response between cigarette use and incident hypertension.9 The results obtained confirmed that smoking constitutes a hypertension risk factor in Hispanic adults. A cumulative dose of smoking above 5 pack-years of exposure raised the risk of hypertension by over 30%. The increased hypertension risk was restricted to current smokers, and did not increase further with higher pack-year levels. This study showed that former smokers were not at higher risk of incident hypertension than non smokers, and underlines additional health consequences of smoking cessation. In a cross-sectional, retrospective study from a tertiary care outpatient setting, Sharma et al. examine in this issue the impact of diagnosing pediatric hypertension based on three-24-hour, day, and night ambulatory blood pressure thresholds (combined ambulatory blood pressure threshold) vs. conventionally used 24-hour ambulatory blood pressure monitoring.10 They find that in children with essential hypertension, the 24-hour and combined ESH thresholds have a stronger agreement for diagnosis of white coat hypertension than for masked hypertension. Hill et al. report in the current issue on a study of sleep quality in untreated hypertensive subjects.11 They show that poor sleep as indicated by low sleep efficiency investigated with wrist actigraphy was associated with impaired endothelial function evaluated by flow mediated dilatation. These results confirm that poor sleep is a cardiovascular disease risk factor, and raise the possibility that improving sleep could contribute to reduce cardiovascular disease risk. To investigate whether physical activity, regardless of weight changes, is associated with reduction in incident hypertension, Kang et al. studied a cohort of 195,045 Koreans with a mean age of 37.7 years.12 Physical activity was measured using a validated questionnaire. Over 616,326.5 person-years, 12,206 participants developed hypertension (19.8 per 1,000 person-years). Higher levels of physical activity and greater weight reduction were associated with less incident hypertension. However, even in the group whose weight increased, subjects who remained active had less incident hypertension, suggesting that in this cohort of young and middle-aged Koreans, physical activity was associated with reduced incident hypertension independently of weight change. The last article in this issue is the yearly publication for World Kidney Day, on living well with kidney disease by patient and care-partner empowerment: kidney health for everyone everywhere. This editorial is published simultaneously with many other journals and authored by members of the World Kidney Day Joint Steering Committee representing the International Society of Nephrology and the International Federation of Kidney Foundation-World Kidney Alliance. The author declared no conflict of interest.

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