© Borgis - Postępy Nauk Medycznych s3/2011, s. 81-82
The new issue of Postępy Nauk Medycznych (Progress in Medical Sciences) is devoted to discussing selected problems concerning epidemiology, pathogenesis and treatment of hypertension.
Docent T. Zdrojewski presents in his article the results of extensive epidemiological studies carried out over the last decade in Poland. They revealed the social dimension of the disease; it is worrying that only two thirds of those suffering from hypertension are aware of the disease and only one in eight are treated effectively. This reflects a disparity between the possibilities of modern therapy and effects of hypertension treatment at the population level. Also it is important that in 30% of Poles high-normal blood pressure (prehypertension) was found. It is worth stressing here the significance of the implemented epidemiological studies because they may play an important role in shaping the direction of the health policy in Poland.
Prof. F. Kokot and Docent L. Hyla-Klekot broadly discuss newly understood mechanisms of renal regulation of water-electrolyte metabolism and blood pressure. They stress the significance of the functional relation of the kidney to other organs. The significance of broadly understood nephrology in the development of medicine was accepted.
Dynamic development of molecular biology techniques have enabled great progress in the studies aiming at explaining the genetic basis of hypertension. It is worth mentioning here the studies on pharmacogenetics that may enable the choice of an appropriate antihypertensive drug based on the “genetic profile”. Prof. A. Ciechanowicz and Prof. S. Czekalski broadly discuss the achievements within studies on the genetic basis of hypertension.
There has been great interest in the dependence between low birth weight and the development of hypertension, ischaemic heart disease, obesity and diabetes mellitus type 2 in later stages of life. The programming of hypertension during fetal life sheds new light on the pathogenesis of hypertension.
Dr. G. Piecha and Prof. A. Więcek discuss the results of experimental and clinical studies devoted to this issue; among other things the significance of the influence of unfavourable environmental factors on fetal development is stressed. According to the authors it is necessary to pay more attention to the factors that may potentially occur during fetal life; this may play an important role in prevention of hypertension.
The article by Prof. T. Guzik concerns the participation of the immunological system in the complex pathogenesis of hypertension. The author analyses, based on his own studies and papers of other authors, mechanisms of activation of the immunological system in hypertension. This is a new view on the pathomechanism of hypertension. The author considers the possibility to use the deepened pathogenic significance of the immunological system in hypertension therapy.
Numerous clinical observations show the significant participation of uric acid in the pathogenesis of hypertension. Interestingly, the antihypertensive effect of allopurinol in patients with hypertension was reported. Docent A. Posadzy-Małaczyńska and Prof. A. Tykarski discuss biological properties of uric acid and the complex character of the relation between uric acid and hypertension, kidney diseases and cardiovascular diseases by additionally addressing the interesting issue of the neuroprotective effect of uric acid.
Over the last few decades there has been constant progress in the methods of measuring blood pressure. A well-proven method is 24-hour blood pressure measurement; also the usefulness of measuring blood pressure in home conditions is stressed. These methods have contributed significantly to the optimization of antihypertensive therapy. Recently, growing significance has been ascribed to the measurement of central aortic pressure, which is connected with the fact that the measurement of blood pressure in the brachial artery does not reflect the pressure in the aorta. Data from the literature show that determining the central pressure in the aorta is characterized by a greater ability to predict cardiovascular events compared to determining the peripheral blood pressure.
Docent P. Jankowski and Prof. K. Kawecka-Jaszcz discuss in their article various aspects of measuring central aortic pressure. This concerns using non-invasive methods of measuring the central pressure, their accuracy and applications in clinical studies. The authors recognize the necessity for further studies that will allow closer determination of the accuracy and prognostic power of this method.
A lot of attention is given to a new, selective renin inhibitor, aliskiren. This is because the compound selectively inhibits the activity of renin – the initial link of the renin-angiotensin system. Aliskiren is the first representative of this group of drugs introduced into clinical practice. Prof. J. Głuszek discusses pharmacological values of the drug, its antihypertensive effectiveness and good tolerance.
The view is expressed that hypertension is the most important risk factor of atrial fibrillation at the population level. It significantly increases the risk of illness and death due to cardiovascular causes and increases the risk of stroke of embolic aetiology. Dr. Emilia Świetlik and Prof. P. Pruszczyk take up the issue, important from the clinical point of view, of codes of practice in patients with hypertension coexisting with atrial fibrillations. Also the usefulness of drugs blocking the renin-angiotensin system in prevention of atrial fibrillation is discussed.
Clinical studies carried out in the last years provided proof that a disturbed sleep structure can play a role in the development of hypertension. In particular, a lot of attention is given to sleep apnoea, which often co-occurs with hypertension; this is a problem of great clinical significance. Sleep apnoea should be remembered in patients with resistant hypertension as well as in patients in whom after the 24-hour measurement a fall of blood pressure at night is not found. Dr. J. Wolf and Prof. K. Narkiewicz discuss the complex pathomechanism of hypertension occurring in patients with sleep apnoea. Attention is drawn to aspects of modern diagnostics and therapeutic codes of practice important from the practical point of view.
In the final presented article the authors describe the long development and constant improvement of pheochromocytoma diagnostic methods (biochemical and imaging). The significance of genetic testing is stressed. The quoted facts illustrate how the achievements of basic science paved the way for the progress of clinical knowledge.
Prof. Włodzimierz Januszewicz