Auteur/autrice : Pr. Michel Burnier

Preeclampsia is a hypertensive disorder specific to gestation that affects 5% to 8% of all pregnancies1 and is associated with a greater lifetime risk for cardiovascular and renal complications.2,3 Recently, different international guidelines have underlined that women who had a hypertensive disorder of the pregnancy should benefit from a postpartum screening and management for cardiovascular risk factors, but with no precise recommendations, especially about the timing of the first medical visit.4–7 The existence and the prevalence of specific hypertensive phenotypes after preeclampsia is not known and the place of ambulatory blood pressure monitoring (ABPM) in the early follow-up of preeclampsia needs to be defined.

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Hypertension and chronic kidney disease (CKD) are global health issues [1] with a strong cause and effect relationship [2]. Both hypertension and CKD are associated with a high risk of cardiovascular (CV) morbidity and mortality [3]. Hypertension together with proteinuria contributes to the progression of CKD [4,5], resulting in an increased CV and all-cause mortality [6,7]. Blood pressure (BP) control in patients with CKD reduces the likelihood of progression to end-stage renal disease (ESRD) and the occurrence of CV events [8]. Therefore, guidelines recommend a target BP of 140/ 90 mmHg with careful monitoring of adverse events (AEs) in CKD patients with proteinuria <1 g/24 h and lower targets in those with proteinuria >1 g/24 h [9–11]. Most recently, the 2017 American College of Cardiology/American Heart Association (ACC/AHA) clinical practice guidelines recommended an aggressive BP goal of <130/80 mmHg in all hypertensive patients including those with CKD [12].

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The kidney has long been placed at the very center of extracellular volume, sodium (Naþ) and blood pressure (BP) homeostasis. Recently, Titze et al. [1] suggested that the skin and muscle also contribute to the regulation of sodium balance in humans. In a long-term Mars flight simulation study, they reported that healthy male individuals accumulated Naþ in considerable amounts without concomitant weight gain, in contrast to the generally accepted theory that changes in total body sodium are paralleled by changes in extracellular volume [2]. They stated that Naþ can accumulate in the skin and muscles where it is stored without being osmotically active, bound to negatively charged glycosaminoglycans, and representing thus a third compartment of storage which is regulated by the immune system [3].

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Today non-communicable (NCD) diseases account for almost 70% of deaths around the World and among them, about one half are due to cardiovascular diseases [1]. Together with tobacco smoking and unhealthy food, hypertension remains one of the leading cause of non-communicable diseases in developed countries, although blood pressure (BP) levels tend to decrease in high-income countries. In contrast, in low-income countries, BP and its burden on health increase continuously [2]. Blood pressure is known to increase with age [3]. Hence, it is not surprising that the prevalence of hypertension is highest in subjects older than 60 years. Thus, in the updated estimates for the prevalence and control of hypertension in the United States for 2015–2016, the prevalence of hypertension was 63% among all adults older than 60 years with a greater percentage in women (66.8%) than in men (58.5%) [3]. Today, a normotensive individual reaching the age of 65 years has a 90% lifetime risk of developing hypertension if she/he lives a further 20 to 25 years [4].

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Redefining diuretics use in hypertension: why select a thiazide-like diuretic ? Michel Burnier, George Bakris, and Bryan Williams

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Cardiovascular events represent a major cause of death in renal transplant patients [1,2]. Renal transplant recipients also constitute a population at very high risk for progressive graft loss and renal events. Although immunological risk factors play an important role in renal survival, it is less recognized that hypertension is probably the major nonimmunological risk factor for graft loss [2]. Accurate diagnosis of hypertension and adequate control of blood pressure (BP) is considered as a fundamental goal in the management of renal transplant patients to lower their cardiovascular and renal risk. However, diagnosis, treatment and monitoring of hypertension remain suboptimal in most renal transplant patients [3]. This editorial is a call for action aiming at improving hypertension control in the transplant population.

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