Abstract
Welcome to this special issue of Therapeutic Advances in Cardiovascular Disease, which is based on a selection of presentations given at a joint meeting of the Inter-American Society of Hypertension (IASH) and the Brazilian Society for Hypertension, held in Salvador, Brazil, in August last year. The journal is grateful to Dr Maria Irigoyen, co-chair of the XXIIth Scientific Sessions of IASH, who coordinated the presentations for the meeting, and who serves as Guest Editor for this issue.
Beginning with a critical appraisal of hypertension practices, Dr Luis Alcocer and colleagues summarize the current guidelines for treating hypertension in the Latin American and Caribbean region, with recommendations for future policies and challenges faced by practitioners. With Chiara Lazzeri as the lead author, the Italian investigators report on a pilot study indicating that early glucose variability in cardiogenic shock after acute myocardial infarction is a marker of mortality, and Dr Alfie shows the benefits of postprandial home blood-pressure monitoring in patients with hypertension. Dr Almeida describes the impact of prenatal care on maternal and fetal outcome in hypertensive disorders during pregnancy.
With regard to renal aspects, Juncos’ group contributes a study on the current approaches to atherosclerotic obstructive renal stenosis, as well as an article on the safety and efficacy of more aggressive blockade of the renin–angiotensin system in patients with chronic kidney disease. This challenging concept is discussed in an accompanying thought-provoking editorial by Dr Maria Bohlke. Brazilian investigators with Dr Greicy Mara Mengue Feniman-De-Stefano as the first author report on a study demonstrating that treatment with spironolactone reduces left ventricular hypertrophy in hemodialysis patients.
Finally, with regard to the mechanisms and putative new pharmacologic targets in hypertension, Ferrario’s group report on the results of a study of the angiotensin-(1-12)/chymase axis in human atrial tissue, showing that enlarged left versus right atrial chambers are associated with increased angiotensin-(1-12) expression and upregulation of chymase gene transcripts, defining an role for this alternative angiotensin II-forming pathway in adverse remodeling of the heart. Novel studies regarding the role of angiotensinogen and the renin/prorenin receptor are documented in accompanying papers from Dr Navar’s research group at Tulane University, LA, USA. Drs Ryousuke Satou, Weijian Shao, and L. Gabriel Navar provide an excellent review of the mechanisms by which renal angiotensinogen contributes to the expression and function of an intrarenal renin– angiotensin system, while the studies described by Alexis A. Gonzalez and Minolfa C. Prieto show how renin and the prorenin receptor interact to increase intratubular angiotensin II formation and the activation of profibrotic genes in renal collecting duct cells. A review by Alberto Mendoza and Eric Lazartigues outlines the new potential therapies and challenges for drug research and development in the central regulation of the renin–angiotensin system, including a new axis, the angiotensin-converting enzyme (ACE) 2/angiotensin-(1-7)/Mas receptor axis, which can serve as a counterbalance to the conventional ACE/angiotensin II/AT1 receptor axis. From Argentina, Dr Gironacci analyses the role of angiotensin-(1-7) as a cerebroprotective agent, adding to a significant database implicating this counter-regulatory axis as a cerebroprotective mechanism. Chilean investigators, with Maria Ocaranza as the lead author, review the key roles of ACE 2 and the vasoactive peptides angiotensin-(1-7), angiotensin-(1-9) and alamandine as counter-regulators of the ACE-angiotensin II axis as well as the biological properties that allow them to regulate blood pressure and cardiovascular and renal remodeling.
With the publication of this issue, IASH renews its commitment to promoting scientific advances that are applicable to the Latin American continent, that showcase the excellence of the emerging science in the research and clinical laboratories of the region, and highlights the importance of fostering new professional and educational liaisons for basic scientists, practicing physicians, and regional medical organizations that are committed to improving the health of the populations living in the area of influence of our society. You can find out more about IASH at www.iashonline.org and the Brazilian Society for Hypertension at www.sbh.org.br