Thirtieth Anniversary of Hypertension
Evolution of a Journal and a Progress Report
This year marks the 30th anniversary of Hypertension, the leading journal dedicated to research on blood pressure regulation and the pathophysiology, clinical treatment, and prevention of hypertension. Although the past 3 decades have brought remarkable changes in the technologies and science of high blood pressure research, the basic goals for Hypertension have remained remarkably constant–to publish the highest quality basic, clinical, and population science research and to promote better care of hypertensive patients.
Birth of Hypertension
The 1970s was an exciting time for hypertension researchers, distinguished by the translation of many decades of research into effective, new approaches for treating high blood pressure. For example, the first peptide angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors became widely available to researchers in the early 1970s, and the first orally active angiotensin-converting enzyme inhibitor was described in 1977. After decades of increasing death rates from cardiovascular disease, the 1970s heralded declining rates of cardiovascular mortality attributed, in large part, to the development and use of more effective drugs to treat patients with hypertension. Publications in the field of hypertension increased exponentially. Yet, establishing a journal devoted solely to hypertension had a difficult beginning.
Lou Tobian, Chair of the American Heart Association (AHA) Council for High Blood Pressure from 1975 to 1977, reminisced in his editorial, “I was looking for a special project … the entire field of high blood pressure was expanding at a fast clip. The whole situation cried out for a new journal dedicated to the general area of hypertension. It would be the first in the world …. The idea was broached informally and met some stiff resistance.” The chair of the AHA Publications Committee was, according to Tobian, “… strongly opposed to the creation of this new journal.”1 Fortunately, the chair was absent when Tobian made his pitch to the AHA Publications Committee, and some other members were supportive. Tobian recounts that, “Arthur Guyton got up and gave a ringing endorsement of the new journal. Jake Coffman did likewise, along with several others. And the chairman was not there to rain on our parade; so, mirabile dictu, a vote was taken and the committee voted strongly in favor of the new journal.”
The second major hurdle was to convince the AHA Steering Committee, which made the final decision. However, the cards were stacked in favor of the new journal, because Harriet Dustan, AHA president-elect, and John Shepherd, AHA president, were both members of the Council for High Blood Pressure Research and strongly supported the establishment of Hypertension.2 The vote of the committee was close, and Shepherd apparently cast the deciding vote to launch the journal, with final approval of the board to establish Hypertension coming in early 1978.2 Thus, Hypertension was launched almost 2 years after initial discussions began, although not without great effort by Tobian, Dustan, Shepherd, and several other members of the Council for High Blood Pressure Research.
The Birmingham Years (1979–1983)
The AHA stipulated that, “The journal must be of high quality, provide critical peer-review of submitted articles, publish results of both laboratory and clinical investigations, be international, become self-supporting, and submit to a progress review in 3 years to decide its value to the field and its future viability.” Harriet Dustan was selected as founding editor, and the Birmingham, Alabama, office for Hypertension opened in June 1978 with Henry Overbeck and Suzanne Oparil serving as associate editors. Only 76 manuscripts were received by the end of the year, but the first issue published in January 1979 got the journal off to a good start. Articles published in the inaugural issue came from a stellar group of hypertension laboratories, including those of Mike Peach, Lou Tobian, Suzanne Oparil, Bonita Falkner, Leonard Share, Wilber Sawyer, Robert Tarazi, and Emmanuel Bravo.
Dustan convinced many members of the council to submit their best articles to Hypertension, and submissions gradually increased; after 13 months, the journal had received ≈200 manuscripts. Hypertension also published the proceedings of the annual meeting of the Council for High Blood Pressure Research, which had been published previously in Circulation Research.
The early success of this new journal was attributed in large part to the support of the Council for High Blood Pressure Research and the foresight and leadership of its founding editors, who stated the following in their initial editorial:
Its editors are committed to developing a journal of high quality that is broadly based and covers all aspects of the field, not just a part of it—a journal that explores new areas, not just those already accepted as important. The field of hypertension is multi-disciplinary, and the journal will serve its purpose only if it provides bridges among the many disciplines. It must stimulate thought and air scientific controversies. It must be a forum not only for results of laboratory investigation but also of clinical research … it must serve the science of hypertension and promote the better care of hypertensive patients.3
The Boston Years (1984–1988)
Under the leadership of its founding editors, Hypertension fulfilled and surpassed the conditions set by the AHA for its ongoing existence. After 5 years, the editorship was transferred to Edgar Haber and his team, which included Victor Dzau, Robert Graham, and Randall Zusman in Boston, Massachusetts. Manuscript submissions continued to increase, and Hypertension became a monthly publication in 1986. Hypertension also became an international journal with non-US manuscript rates rising to 41% of submission, and, in 1987, 48% of subscribers were from countries other than the United States. During Haber’s editorship, the journal embraced newly developing areas of cellular and molecular mechanisms while continuing to meet the needs of physiologists, pharmacologists, clinicians, and epidemiologists.4
The Iowa Years (1989–1993)
The second decade of the journal began in Iowa, with Allyn Mark as editor and Francois Abboud, Gerald DiBona, Donald Heisted, and Larry Tobacman serving as associate editors. In his inaugural editorial, Mark emphasized that, “The journal may change, but that change will reflect the contributors, reviewers, and the field of hypertension as much as the editors. The editors can only steer, not power, a journal. The momentum is generated by the contributors.”5 When Mark stepped down as editor in 1992, Jerry DiBona served as editor for 1 year. During the 5-year term of the Iowa editorship, which ended in 1993, manuscript submissions had increased to 600 per year, and acceptance rates averaged 42%.6
The New Orleans Years (1994–2001)
In 1994, the editorship transferred to Ed Frohlich in New Orleans, with Gabriel Navar and Richard Ré serving as associate editors. A major focus of Frohlich’s editorship was to improve publication “hang time” and reduce the time required for review of manuscripts. Frohlich promised that, “All manuscripts submitted with their computer desk–generated diskettes will be placed on a faster track toward publication.” This was before the age of online submissions and review, which have since greatly expedited the review process. The New Orleans editor team served 8 years, whereas previous teams had served only 5 years. During Frohlich’s 8-year editorship, manuscript submissions nearly doubled, with notable increases in clinically oriented publications and submissions of manuscripts emanating from outside the United States. In his closing editorial, Frohlich noted that the condition of Hypertension was “hale and hearty.”7
Progress Report for Hypertension From 2002 to 2009
The stewardship of Hypertension transferred to Jackson, Mississippi, in 2002, with the initial editorial team consisting of John Hall as editor and Joey Granger, Dan Jones, and Celso Gomez-Sanchez from Jackson; Curt Sigmund from Iowa City, Iowa; Fred Luft from Berlin, Germany; and Ernesto Schiffrin from Montreal, Quebec, Canada, as associate editors. Thus, Hypertension had an international team of editors for the first time. Over the past 7-plus years, new associate editors, including Jan Staessen (Belgium), Richard Roman (Milwaukee, Wisconsin), and Nancy Brown (Nashville, Tennessee) have joined the team, each bringing a special perspective and expertise. Dan Jones and Curt Sigmund stepped down as associate editors when they became, respectively, president of the AHA and editor-in-chief of another journal; however, both continue to serve Hypertension as a consulting editor (Jones) or as a member of the editorial board (Sigmund).
We were fortunate that our predecessors handed the journal to us not only in good shape but also as the premier journal in its field. Our main goals since assuming the editorship have been as follows: (1) to ensure the publication of the highest-quality original basic, clinical, and population research related to hypertension; (2) to increase the readership and scientific importance of Hypertension; (3) to ensure rapid and fair reviews and rapid publication of articles after acceptance and to provide the highest possible level of efficiency and “customer satisfaction” in our office operations; and (4) to effectively serve the international community of hypertension researchers and clinicians and to provide an important vehicle for achieving the mission of the AHA and its scientific councils.8
The goal of publishing the best articles on hypertension research continues to be challenging because of the many other cardiovascular and hypertension journals that compete for these articles. As Irvine Page pointed out in his recollection of the history of the Council for High Blood Pressure Research, “… With the creation of subspecialties, such as nephrology, stroke, molecular pharmacology, and several others, the plan to hold all-inclusive meetings began to crumple …. The same sort of problems occurred with the weed-like growth of journals as new societies were founded.”9 Although journals devoted to hypertension continue to sprout up almost yearly, encompassing both clinical and basic sciences, Hypertension remains the top journal in its field and has thrived despite increasing competition. This is evidenced by the steady growth of submissions to Hypertension (Figure 1) and by the fact that the Journal Citation Reports scientific impact factor for Hypertension continues to increase (Figure 2). This past year, the impact factor reached a new high of 7.368, considerably above its nearest competitor for hypertension journals.
Online submissions and reviews for Hypertension were implemented in 2002, resulting in improved efficiency of the review process. The time from submission to first decision decreased over the past 7 years to its current level of ≈2.5 weeks (Figure 3). Equally important as rapid review is the time from acceptance to the publication of articles. As shown in Figure 4, the current time from manuscript acceptance to print publication is ≈7.5 weeks. The time from acceptance to online publication is <4 weeks. Although we could publish articles online faster (within a few days after acceptance), only copyedited manuscripts are published online, rather than the unedited version, as is done in some journals. This ensures quality control of online articles and accuracy of information that is important to clinicians in treating their patients.
Hypertension has continued to mature as an international journal and as a journal that publishes a good balance between basic and clinical research. In 2008, manuscripts were submitted from 49 countries. Approximately 58% of manuscripts submitted were clinical or population science, and 42% were basic science manuscripts.
As submissions to the journal have grown, the AHA has increased its allotment of published pages. In 2008, Hypertension published 2842 print pages plus 200 online pages compared with a total page budget of only 660 in 1979. However, the increase in manuscript submissions has exceeded the growth of the page budget, and there has been a gradual reduction in the acceptance rate to its current level of 18% to 20%. This acceptance rate has remained stable for the past 3 years and appears to be a reasonable level to ensure publication of the highest quality articles and to still remain within the page budget allocated by the AHA Scientific Publishing Committee.
One of the important goals for Hypertension throughout its 30-year history has been to provide a valuable resource to healthcare professionals who treat patients with hypertension. To accomplish this objective, the journal has published numerous guidelines and articles that are mainly “practical” in their application of research to the effective treatment of hypertension. To reach as many clinicians as possible, the journal makes all of its clinical guidelines and scientific statements freely available and, in 2008, initiated a Continuing Medical Education feature for practicing clinicians. Many clinical articles are also published in foreign languages (currently Korean, Spanish, Italian, and English) to reach healthcare professionals in countries where English is not the native language.
The Council for High Blood Pressure Research was the driving force for the birth and development of Hypertension and continues to strongly support the journal. The Council on Kidney and Cardiovascular Disease and the Inter-American Society of Hypertension also adopted Hypertension as their official journal. Thus, the proceedings from the annual joint meeting of the Council for High Blood Pressure Research and the Council on Kidney and Cardiovascular Disease, as well as the proceedings of the biannual meeting of the Inter-American Society of Hypertension, are published in Hypertension.
Summary and Perspectives
Hypertension had a difficult birth but has developed into the top journal in its field. This success has been attributed to the strong support of the many loyal readers and contributors to the journal and the adherence to the basic principle of publishing only the highest quality research. During the 30 years of its existence, many important research advances in hypertension and related cardiovascular disease, stroke, and kidney disease have been reported in the journal.
Yet, despite the successes of Hypertension, we obviously cannot be satisfied with the current state of affairs in the treatment of hypertension. Although hypertension research has delivered unprecedented understanding of blood pressure regulation and excellent antihypertensive therapies, suboptimal blood pressure control is still the most important risk for death and is globally responsible for >7 million deaths annually.10,11⇓ Current data indicate that hypertension accounts for >50% of all coronary heart disease, and the number of people worldwide with hypertension is estimated to be >1 billion.12 Despite overwhelming evidence that effective control of blood pressure can do more to reduce cardiovascular disease and mortality than any other known treatment, and although safe and effective drugs are widely available at relatively low cost, the control rates for hypertension are unacceptably low. In the United States, for example, almost two thirds of hypertensive patients are not being controlled to blood pressure levels <140/90 mm Hg, although there is clear evidence that blood pressure goals should be even lower than this traditionally accepted level of “hypertension.” The reasons for these poor control rates for hypertension are still unclear, although there are numerous examples illustrating that substantial improvement of control rates can be achieved even in the face of new challenges, such as the emerging “epidemic” of obesity.
Unacceptably low control rates for hypertension, new challenges to our understanding of blood pressure regulation associated with the increasing prevalence of obesity and associated metabolic and cardiovascular diseases, and rapid growth in technologies that permit unprecedented insights into molecular mechanisms are the main reasons that hypertension research will continue to offer many opportunities for investigators. The field has broadened tremendously in the past 30 years, encompassing molecular biology, genetics, immunology, developmental biology, physiology, pharmacology, neuroscience, nephrology, endocrinology, cardiology, population sciences, and other areas that have not traditionally been considered within the domain of hypertension research. It is for all of these reasons that the vitality of Hypertension is promising. However, we are always mindful that Hypertension should be an important vehicle not only for reporting the latest research advances but also for improving the treatment of hypertension and related cardiovascular and renal diseases.
The current team of editors is committed to the principles on which Hypertension was founded. We are grateful to the many authors and reviewers who provide the driving force for the journal’s excellence. Without the support of the readers, contributors who submit their best work, outstanding editorial board members and referees who fairly and efficiently review the manuscripts, and a dedicated office staff, led by Gerry McAlpin (managing editor), we could not meet our goals and those of the founding editors of Hypertension. Thanks to all of you for 30 years of strong support of Hypertension.
The opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.
- ↵Tobian L. Story of the birth of a journal called Hypertension. Hypertension. 1999; 33: 7.
- ↵Dustan HP. The beginnings of Hypertension. Hypertension. 1999; 33: 609–610.
- ↵Dustan HP. Hypertension: a new journal. Hypertension. 1979; 1: 1–2.
- ↵Haber E. Ten years of Hypertension. Hypertension. 1988; 12: 529.
- ↵DiBona GF, Mark AL, Heisted DD, Tobacman LS. Swallowing the anchor. Hypertension. 1993; 22: 797.
- ↵Frohlich ED. “Hale” and farewell: an epilogue after 8 years. Hypertension. 2001; 38: 1233–1234.
- ↵Hall JE. Hypertension: opportunities and challenges. Hypertension. 2002; 39: 1–2.
- ↵Perkovic V, Huxley R, Wu Y, Prabhakaran D, MacMahon S. The burden of blood pressure-related disease: a neglected priority for global health. Hypertension. 2007; 50: 991–997.
- ↵Jones DW, Hall JE. World Hypertension Day 2007. Hypertension. 2007; 49: 939–940.
- ↵Jones DW, Hall JE. Hypertension: pathways to success. Hypertension. 2008; 51: 1249–1251.