Nutrition and Higher Blood Pressure in Blacks (page 1074)
For decades, the high rate of prehypertension/hypertension among adult black women and men has been a major unresolved challenge and problem for American medicine, alleviated to a limited degree by development of antihypertensive drugs but with continued expression in excess cardiovascular morbidity, disability, and premature death in blacks. The population-based data presented here imply that improved nutrition can play a role in preventing and controlling adverse blood pressure. In particular, for people, generally (including blacks), appropriate dietary emphases encompass vegetables, fruits, whole grains, legumes, fish and shellfish, low-fat and fat-free dairy products, egg whites, low-fat poultry, unprocessed lean red meats on occasion; portion sizes modest, not huge; olive oil and seed oils in modest amounts; food products uniformly low-salt or no salt, no addition of salt in the kitchen or at the table; alcoholic beverages (if desired) in modest amounts (eg, a glass of wine with one meal per day); dietary de-emphases: fatty meats, processed meats, high-fat dairy products, commercial baked goods (cakes, cookies, pies), pickled and other high-salt products, egg yolks, “hard” spreads (butter, “hard” margarines), and oils high in saturated fat (eg, coconut oil, palm oil).
Physicians should do all they can, in both their medical care and public health roles, to counsel and assist all blacks to enjoy the pleasures of the table heart-healthy style at all stages of their lives.
Hypertension Risk in Young Adults (page 1015)
In the United States, 29% of adults have hypertension and an additional 28% have prehypertension. Prehypertension was added to national guidelines as an official blood pressure classification within the past decade, but this classification may not be sufficient for identifying those at high risk for hypertension. In this issue of Hypertension, Carson et al investigated the predictive ability of the Framingham Heart Study (FHS) hypertension risk prediction model, which includes demographic and clinical parameters that are routinely collected in clinical practice, and compared its performance with the prehypertension classification alone in a cohort of young adults. They demonstrated that the FHS model of age, sex, systolic blood pressure, diastolic blood pressure, body mass index, cigarette smoking, and parental history of hypertension performed better than the prehypertension alone model for predicting who would and would not develop incident hypertension during the 25-year follow-up period. The FHS model performed well for both blacks and whites in the community-based Coronary Artery Risk Development in Young Adults Study; however, the predicted hypertension risk obtained from the FHS model had to be calibrated for use in the young adult population. This suggests that the FHS model may need to be calibrated when applying it to other populations. These findings highlight the benefit of using demographic and clinical parameters to improve hypertension risk assessment and the ongoing need for preventive measures.
Endostatin, Hypertension Duration, and Organ Damage (page 1146)
Endostatin is a biologically active derivate of collagen XVIII, which has been suggested to be a relevant marker for extracellular matrix turnover and remodeling in various diseases. Previous experimental studies have suggested a role of endostatin in the development of cardiovascular disease, and recent observational studies have shown that higher circulating endostatin is associated with an increased risk for cardiovascular events in patients with stroke and recently also in the community-based setting. Yet to date, the role of endostatin in long-term hypertension and hypertensive target organ damage has not been reported. In this issue of Hypertension, Carlsson et al report an association between longer duration of hypertension and higher serum levels of endostatin in 2 independent community-based cohorts. Participants with >27-year history of hypertension had the highest endostatin levels. Interestingly, in participants with prevalent hypertension, cross-sectional associations between higher circulating endostatin and impaired endothelial function, increased left ventricular mass and higher urinary albumin/creatinine ratio were found. These data provide additional support for the importance of increased extracellular remodeling in hypertensive disease and put forward serum endostatin as a novel promising biomarker for vascular, myocardial, and renal hypertensive organ damage. Additional studies are warranted to investigate the underlying mechanisms of these associations and to evaluate whether circulating endostatin levels can be a clinically relevant biomarker for subclinical cardiovascular damage used to identify hypertensive individuals at particularly increased cardiovascular risk.
- © 2013 American Heart Association, Inc.