Editor’s Corner
Factors influencing blood pressure levels
Alberto Zanchetti
A
s usual, this short editorial introduction tries to
provide the readers with a lead by which to get
through the content of the current issue of the
Journal of Hypertension.
An important topic, upon which an initial group of
articles are focused, is that of the factors influencing blood
pressure levels. The issue opens with a Consensus Docu-
ment produced by the Working Group on Obesity, Dia-
betes and the High Risk Patient of the European Society
of Hypertension regarding the pathogenesis of obesity-
induced hypertension (Kotsis et al., pp. 1499–1508).
Although obesity is clearly associated with an increased
prevalence of hypertension, it is also known that many
obese individuals do not develop hypertension. The expert
Consensus Document clearly discusses a number of pro-
tective and promoting factors for hypertension in obesity,
and highlights gaps in our current knowledge. Within
the same area of the influences of obesity on blood pres-
sure, a large population study in China by Wang et al.
(pp. 1555–1562) shows that measurements of the visceral
fat index (VFI) or of the VFI to percentage body fat ratio
(VFI/PBF) may provide a better understanding of adiposity-
related risks for hypertension and prehypertension.
Another important factor influencing blood pressure is
reviewed by Binia et al. (pp. 1509–1520), who publish a
meta-analysis of randomized controlled trials of potassium
supplementation, showing that this is associated with a
reduction of blood pressure in individuals who are not
on antihypertensive medication, and the effect is significant
in hypertensive individuals. A meta-regression analysis
shows that the reduction in blood pressure significantly
correlates with decreased daily urinary sodium-to-potass-
ium ratio and increased urinary potassium.
A large study from Finland (Laine et al., pp. 1549–1554)
has explored the hypothesis that vigorous physical activity
during young adulthood protects against hypertension later
in life and reports that former elite athletes (2037 versus
1403 matched controls) had lower age-adjusted prevalence
of hypertension than controls, the protective effect of past
exercise being particularly marked in former endurance
athletes. The authors conclude that a former career as an
elite athlete not only seems to be associated with a lower
prevalence of hypertension in later life, but also the current
volume of leisure-time physical activity is inversely related
to the presence of hypertension.
Stress being another factor often associated with blood
pressure elevation, Schoen et al. (pp. 1571–1579) have
measured copeptin, a vasopressin-related stress hormone,
in a large cohort of over 2000 healthy young adult individ-
uals, and found plasma levels of copeptin were significantly
Journal of Hypertension
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
associated with an increased blood pressure variability in
both sexes and an elevated night-time blood pressure
among men. In an accompanying editorial, Schillaci et al.
(pp. 1524–1527) remark that the findings of Schoen et al.
suggest circulating copeptin may be considered as an
integrated marker of the stressful events associated with
sleep apnoea and a harbinger of future cardiovascular
complications. Finally, the often reported associations of
either foetal growth restriction or prematurity with elevated
blood pressure in adult life has been further investigated by
Juonala et al. (pp. 1542–1548) in the context of the Car-
diovascular Risk in Young Finns Study, who suggest that
both factors are likely to play a role, their 31-year long
follow-up of 1756 individuals showing that elevated blood
pressure levels associated with prematurity are more likely
to be present in those with foetal growth restriction.
Two other articles focus on the influences exerted by
blood pressure levels, specifically on organ damage. Satoh
et al. (pp. 1536–1541) report that blood pressure variability
is associated with a known cardiovascular risk predictor, N-
terminal proB-type natriuretic peptide (NT-proBNP), and
suggest that the association of blood pressure variability
with NT-proBNP levels may be taken to indicate that blood
pressure variability is associated with organ damage or
complications. In an accompanying editorial, Bilo et al.
(pp. 1521–1523) point out that, although the results
reported by Satoh et al. do not have an immediate clinical
applicability, they generate stimulating hypotheses on early
cardiac alterations related to cardiovascular dynamics.
Obviously, testing these hypotheses will require further
research. The role of organ damage in predicting cardio-
vascular risk is also enlightened by a study in which Greve
et al. (pp. 1563–1570) have found that both an elevated
urinary albumin to creatinine ratio and presence of athero-
sclerotic plaques in the carotid artery (but not an elevated
pulse wave velocity) can identify individuals with actual high
cardiovascular risk (cardiovascular event incidence during
follow-up) despite being classified at moderate/intermediate
risk with SCORE or Framingham risk algorithms.
In this issue of the Journal, a large body of research is
devoted to blood vessel functional and structural changes.
Journal of Hypertension 2015, 33:1497–1498
Istituto Auxologico Italiano and Centro Interuniversitario di Fisiologia Clinica e Iper-
tensione, Università di Milano, Milan, Italy
Correspondence to Alberto Zanchetti, Centro di Fisiologia Clinica e Ipertensione,
Università di Milano, Via F. Sforza, 35, Milan 20122, Italy. Tel: +39 02 50320484;
e-mail: alberto.zanchetti@unimi.it
J Hypertens 33:1497–1498 Copyright ß 2015 Wolters Kluwer Health, Inc. All rights
reserved.
DOI:10.1097/HJH.0000000000000667
www.jhypertension.com 1497
Zanchetti
Vascular fibrosis is the focus of two articles: Fedorova et al.
(pp. 1602–1610) report that aortic fibrosis induced by
marinobufagenin, an endogenous cardiotonic steroid, is
responsive to the mineralocorticoid antagonist, canrenone.
In a mechanistic article, Xu et al. (pp. 1611–1623) find that
in high fat fed obese mice made knockout for the BK (large
conductance Ca2þ-activated Kþ) channel ß1-subunits have
higher norepinephrine reactivity, greater wall thickness and
collagen accumulation in the mesenteric arteries than wild-
type mice. The authors suggest that BK channel deficiency
promotes sympathetic activity and vascular remodelling
and fibrosis. Endothelial dysfunction is the object of two
articles: Gu et al. (pp. 1624–1632) report that chemerin, a
recently discovered adipokine elevated in obesity and
metabolic syndrome, is an independent predictor of
impaired endothelial function and increased stiffness
in hypertension. Fontes-Guerra et al. (pp. 1666–1675)
find that nitroglycerin-mediated, but not flow-mediated,
vasodilatation is independently associated with higher
night-time blood pressure and nondipping patterns in
patients with resistant hypertension, and suggest that it
may be a better cardiovascular risk marker in this type of
patients. This article is commented by Palatini and Grassi
(pp. 1533–1535), who remark that the cross-sectional
nature of the study by Fontes-Guerra et al. does not allow
us to understand whether the endothelial/vascular dysfunc-
tion is the causative factor or the consequence of the high
nocturnal blood pressure.
Two articles from the Maastricht study focus on the role
of serum uric acid on vascular function: neither stiffness of
large arteries nor skin microvascular function was found
correlated with serum uric acid after suitable adjustments
(Wijnands et al., pp. 1642–1650). These findings are com-
mented by Virdis and Grassi (pp. 1531–1532), who point
out that the authors are the first to have utilized a high-
quality methodology for exploring the relationship
between uric acid and skin microvascular function, but
the problem whether skin microcirculation can be regarded
as a model of microvascular function in all vascular beds
remains open.
In elderly hypertensive patients from Korea, Cho et al.
(pp. 1633–1641) report that heavy aortic calcification is
associated with arterial stiffening and suggest that this
association may underlie the left ventricular hypertrophy
often occurring in elderly hypertensive individuals. Another
mechanistic experimental study deals with cardiac hyper-
trophy (Lu et al., pp. 1676–1687), showing that in rats with
abdominal aortic constriction, the ensuing cardiac hyper-
trophy can be prevented by administration of intermedin
(IMD), a novel member of the calcitonin/calcitonin gene-
related peptide family. The authors suggest that IMD may
exert its effect on cardiac hypertrophy by inhibiting endo-
plasmic reticulum stress and apoptosis, possibly via acti-
vation of AMP-activated protein kinase (AMPK) signalling.
Other mechanistic articles, though in different areas of
hypertension research, are focused on mechanisms of the
1498 www.jhypertension.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
increased cardiovascular risk of orthostatic hypotension
(Isma et al., pp. 1594–1601, suggest that one mechanism
may be an increased concentration of von Willebrand
factor) and on mechanisms of preeclampsia [Li et al.,
pp. 1658–1665, show that trophoblast cells respond to
cell-free foetal DNA through the interferon (IFN)-inducible
protein 16 (IFI16) receptor, resulting in the production of
preeclampsia-related antiangiogenic factors].
Two methodological articles refer to blood pressure
measurement procedures. Kang et al. (pp. 1580–1587)
have compared the accuracy of home blood pressure
monitoring in the diagnosis of white-coat and masked
hypertension in comparison with ambulatory blood pres-
sure, and report home measurements have a high diagnos-
tic specificity but low sensitivity. In an accompanying
editorial, Stergiou et al. (pp. 1528–1530) remark these
findings support the position of the European Society of
Hypertension, that recommends home blood pressure
measurement as a reliable alternative to ambulatory
monitoring. Young et al. (pp. 1588–1593) have investigated
the reliability of oscillometric central blood pressure and
augmentation index calculations, and conclude that the
highest reliability is obtained when participants are supine
and fasted.
As usual, therapeutic aspects are also covered in the
current issue of the Journal. On the basis of the longitudinal
data of the China Health and Nutrition Survey, Guo et al.
(pp. 1688–1696) report that between 1991 and 2001, blood
pressure and hypertension prevalence have increased
among Chinese adults. Although the levels of awareness,
treatment and control of hypertension have increased, they
have remained at quite low levels. Two studies concern
long-term chronic baroreflex activation therapy in resistant
hypertension: Halbach et al. (pp. 1697–1703) have inves-
tigated acute blood pressure increases and decreases after
device deactivation and reactivation (on/off effects) in
patients on chronic unilateral baroreflex stimulation and
found that there is a significant on/off effect on blood
pressure supporting the continuing efficacy of the stimu-
lation. Persistent efficacy of chronic baroreflex stimulation
is also reported by Gronda et al. (pp. 1704–1708) in
patients with heart failure, in whom improvements
observed after 6 months were found maintained at
12 months after initiation of stimulation, the improvements
including reduced sympathetic activity and hospitalization
rates.
Finally, the current issue also includes a case report of an
interesting case of reninoma, which has allowed a detailed
study of tumoral cells in culture (Vidal-Petiot et al.,
pp. 1709–1715).
ACKNOWLEDGEMENTS
Conflicts of interest
There are no conflicts of interest.
Volume 33
Number 8
August 2015