Title:Editorial(Thematic Issue: Hypertension and Diabetes – Update in 2013)
VOLUME: 9 ISSUE: 4
Author(s):Kazuko Masuo
Affiliation:Human Neurotransmitters Laboratory Nucleus Network Ltd., Baker IDI Heart & Diabetes Institute, Melbourne Victoria 3004 Australia.
Abstract:The increase in the prevalence of obesity, which has been considered as an epidemic by the World Health Organisation, is a
serious, worldwide, health problem. Importantly, hypertension and diabetes are frequently associated with obesity, and,
together, they constitute a significant burden, in terms of both morbidity and health care costs. The association with increase in
the prevalence of obesity, prevalence of hypertension and diabetes have elevated significantly in the last decade. The driving
forces linking obesity, hypertension, and diabetes remain to be clarified due in part to the fact that environmental, genetic, life
style and behavioural confounders are involved generating the disease state. Additionally, it is recognized that neuroendocrine
mechanisms, including insulin resistance, sympathetic nervous activation, and stimulation of the rennin-angiotensinaldosterone
system (RAAS), are related to obesity, hypertension, and type 2 diabetes. Importantly, taken in isolation, obesity,
hypertension, and diabetes are all associated with increased risk of the development of cardiac and renal complications.
However, with coexistence of diabetes and hypertension, the risk is elevated substantially more.
I edited “Hypertension and type 2 Diabetes in Obesity” in 2011 as a special issue. After 2011, numerous investigations have
been reported to prevent hypertension, diabetes and related cardiovascular risks. This special issue entitled by “Hypertension
and Diabetes –Update in 2013” includes several new discoveries /findings such as Nasfatin/Nucleobindid-2 and salt-sensitivity
in obesity-hypertension. In addition, this issue is honoured to include a section on dyslipidemia consisting of 3 reviews written
by Director and Dr. Morales-Villegas, who was featured as a hot topic in the European Society of Cardiology-2013 regarding
lifestyle modification in Mexican young population to prevent cardiovascular risks. This special issue has been edited
systematically, from [1] mechanisms and pathophysiology, [2] complications, and [3] treatments for practical usage. Therefore,
several parts based on but updated from the previous issue over the last 3 years.
[1] The mechanisms and pathophysiology includes the following; (i) the mechanisms of hypertension, especially focused on
the sympathetic nervous activity, and renal denervation in patients with resistant hypertension by Masuo; (ii) Reninangiotensin-
aldosterone system (RAAS) including recent clinical trials findings with blocking agents of the RAAS by Kamide;
(iii) The relations between adrenoceptor polymorphisms, hypertension and diabetes (metabolic syndrome) was updated over the
last 3 years by Masuo; (iv) Blood pressure variability (dipper versus non-dipper) in hypertension and diabetes by Eguchi, (v)
Sympathetic nervous activity in salt sensitivity by Ando. This author, himself, is one of the first investigators to show increased
salt sensitivity in obese hypertension. And (vi) recently discovered anorexigenic protein, nesfatin-1 and glucose metabolism by
Shimizu and Osaki, who was one of the investigators for discovering the protein. This protein may be a candidate of treatments
for obesity and diabetes.
[2] “Complications” includes (i) Cardiac complications in hypertension and diabetes, especially focused on the role of the
sympathetic nervous activity, by Kishi and Hirooka; (ii) Atherosclerosis and lipids metabolism by Morales-Villegas. Patients
with diabetes and hypertension frequently have atherogenic diseases and dyslipidemia. Atherosclerosis and abnormal lipids
metabolism are a serious risk factor for cardiovascular mortality and morbidity. First, he reviewed the relationship between
dyslipidemia, hypertension and diabetes covering a wide range of information such as epidemiology, mechanism,
cardiovascular risk factors. And then he moved to “Coronary atherosclerosis in women”, which is different from “male” pattern
of coronary atherosclerosis. And he discussed the molecular biology on PCSK9-LDLR, which regulates the entry of cholesterol
into the cell to stabilize the intracellular cholesterol concentration. In the previous special issue in 2011 entitled “Hypertension
and Diabetes in Obesity”, he wrote a very helpful review to understand why statins can reduce cardiovascular risks. Taken
together, I think most of new knowledge on lipids metabolisms in hypertension and diabetes have been covered.
[3] The first step to treat for diabetes and hypertension in obesity is weight loss with lifestyle modifications, however, many
patients fail to achieve the blood pressure goal with only lifestyle modification. “Treatments for hypertension in obesity: Nonpharmacological
and pharmacological measurements-update in 2013” was updated on “Treatments on obesity-related
hypertension” in Current Hypertension Reviews (2011, vol 7:pp184-200)” by Masuo. Most important thing to treat
hypertension in type 2 diabetes is the target of blood pressure reduction is lower (<130/85 mmHg) than non-diabetic patients
due to higher prevalence of cardiac and renal complications in diabetic patients. Furthermore, weight loss can help the efficacy
of antihypertensive medications.
This special issue covered a wide range of “Hypertension and Diabetes” including pathophysiology, complications and
treatment, but all articles are very unique. The editor would thank the authors for their contributions and the reviewers for their
226 Current Hypertension Reviews, 2013, Vol. 9, No. 4 Editorial
help. I enjoyed to edit a variety of articles, and learned systematically from the editing. I hope that this special issue is useful for
your clinical medicine, research and preventing cardiovascular risks from hypertension and diabetes worldwide.
