April 2010

The Importance of Hypertension in Disease

 

For more information

• To learn more about hypertension, see the Journal of Biological Chemistry minireview series “Biochemistry in Hypertension.”

• Click here to see the program for the hypertension session at the annual meeting.

Even for clinicians and researchers who work with hypertension every day, the scope of the disease is staggering. Hypertension affects some 60 million Americans and more than 1 billion individuals worldwide. The disease ranks as the single-most common reason to visit a doctor’s office (1). And, when the relationship between hypertension and other diseases is considered, the full impact of hypertension becomes clear.

According to the World Health Organization, disease attributable to hypertension is the No. 1 cause of mortality in the world (2). Hypertension is a major risk factor for cardiac disease and stroke, with an increase in risk for these ailments with progressively higher blood pressures (3). High blood pressure is the second-leading cause of end-stage renal disease, and its presence increases the rate of progression of all kidney diseases (3). Because of this, hypertension will be a central theme at the American Society for Biochemistry and Molecular Biology meeting in Anaheim, with a session titled, “Hypertension: Treatment, Disparities and Molecular Mechanisms.”

Despite the importance of hypertension, our understanding of the disease’s pathogenesis remains poor. Given that the various known inherited forms of hypertension have been linked to mutations in kidney-tubule transporters and channels, it is clear that the kidney plays an essential role in blood pressure regulation and the pathogenesis of hypertension. One of the central ion channels for sodium regulation in the kidney is the epithelial sodium channel, which will be discussed by Thomas R. Kleyman in his presentation “Epithelial Sodium Channels and Hypertension” and David Pearce in his talk, “Regulation of Ion Channel Trafficking.” Another key transporter is the sodium chloride co-transporter, which Robert Hoover will cover in “Mechanisms of Hormonal Regulation of the Sodium Chloride Co-transporter.”

Although a number of agents are now at our disposal for therapies, treatment of hypertension remains inadequate. According to National Health and Nutrition Examination Survey data, only one in three hypertensive Americans has well-controlled blood pressure (3). Well-controlled, in this sense, is defined as a blood pressure reading of less than 140/90 mmHg. While lower blood pressures correlate with improved mortality, treatment is much more than controlling a number. John Flack will address the issue in his presentation, “Contemporary Approaches to Risk Stratification and Treatment.”

Understanding the goals, strategies and targets for hypertension treatment in patients with other co-morbidities is essential for dealing with the disease. Those issues will be addressed by Shawna Nesbitt, Kenneth A. Jamerson and Jackson Wright as they present their talks “Treatment in the Context of Other Diseases,” “Avoiding Cardiovascular Complications in People Living with Systolic Hypertension, the ACCOMPLISH trial” and “Combination Therapies to Treat Hypertensive Patients with CKD.” And, finally, the larger impact of hypertension in African-Americans will be discussed by Janice Lea in her presentation “Racial Disparities in Hypertensive Cardiovascular Disease and Chronic Kidney Disease.”

Hypertension remains a critical public health concern, one that we truly still do not understand. Current research, however, is bringing us closer to that goal, giving us insights into the disease’s scope, pathogenesis and treatment.

References

1. Cherry, D. K., Hing, E., Woodwell, D. A., and Rechtsteiner, E. A. (2008) National Ambulatory Medical Care Survey: 2006 Summary. Natl. Health Stat. Report 6, 1–39.

2. WHO (2002) The World Health Report 2002- Reducing Risks to Health, Promoting Healthy Life. Rev Ed Ed., World Health Organization Press.

3. Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jr., Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T., Jr., and Roccella, E. J. (2003) Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension 42, 1206–1252.

Benjamin S. Ko (bko@medicine.bsd.uchicago.edu) is an assistant professor at the University of Chicago.


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