Editorial [Hot Topic: Modifying Cardiovascular Risk Factors: Epidemiology and Characteristics of Hypertension-Related Disorders (Executive Guest Editor: Aurelio Leone)]

Usually, many papers on the hypertension start with, approximately, the following words: hypertension is a major risk factor for developing coronary heart disease and stroke. This statement may seem, at first sight, a trite sentence of introductory type, but, on the contrary, it contains the basic assumption, which defines meaningfully what is and the role of hypertension. Whatever hypertension may be approached, and there are many approaches to assess hypertension: clinical, biological, metabolic, epidemiologic, statistic, pathologic and others, all these approaches able to investigate peculiar characteristics of changes in blood pressure values, there is evidence that severe pathological alterations characterize the outcome of the disease. Moreover, until very recent years there were no unanimous opinions about the definition of hypertension [1-3]. Different opinions came out from three sources: a lack of effective statistical methods able to identify the number of hypertensive individuals due to difficulty in analysing how many people worldwide had rise in blood pressure; the continuously variable distribution of blood pressure among different race and sex, and the value range of both systolic or diastolic hypertension. In a recent past, hypertension was assessed by systolic and diastolic values over respectively 160 mmHg and 95 mmHg [2], which are very far from the current concepts. However, borderline hypertension was established for those individuals who were consistent with blood pressure from 140/90 mmHg to 159/94 mm Hg. Above described values for blood pressure had to be almost stable, since whether they were assessed occasionally, blood pressure was defined unstable or absent hypertension. A dramatic change in establishing whether blood pressure is stably elevated currently exists. High blood pressure is a common disorder in which values remains abnormally high, reading of 140/90 mm Hg or greater. Such a statement is, however, valid for those individuals with no other diseases or cardiovascular risk factors associated [3]. Indeed, recommendations are suggested for special categories of individuals, particularly diabetics, patients with kidney diseases and patients receiving antihypertensive treatment often difficult to conduct since physicians may use a large variety of drugs [4]. The first step to keep in mind is the ability to measure carefully blood pressure because of evaluating elevated blood pressure permitted, in far-off times, to demonstrate that those individuals who were suffering from high blood pressure met a large variety of lethal events [5]. When this statement found its support, a debated question rose: are hypertension and vascular-related events manifestations of a common underlying alteration or, conversely, did hypertension cause vascular disease? A first response to this question seemed to derive by the analysis of a large-scale trial [6]. This study analyzed the diastolic pressure between 115 and 129 mm Hg in 143 men enrolled in a randomized, placebo-controlled trial. Seventy-three individuals received therapy by using hydrochlorothiazide, hydralazine and reserpine while other 70 patients received placebo. Treated men who displayed reduction in diastolic blood pressure had markedly diminished the occurrence of strokes, heart failure and accelerated hypertension without change in rate of coronary heart disease. Obtained results would need different comments. In our opinion, there would be evidence that some vascular events are preferably linked to vessel damage caused by hypertension whereas others, like ischaemic heart disease, which recognizes, pathogenetically, a multifactorial aetiology, have a common substrate with hypertension and, therefore, would follow the same steps that may determine the increase in blood pressure. From the analysis of previous results, there is evidence, however, that the risk linked to elevated blood pressure may be certainly modified with appropriate measures. In addition, always more large-scale clinical trials clearly demonstrated the above statement in every type of population or elevated blood pressure [7- 12]. Changes in lifestyle contribute to reinforce the observed positive results similarly to what happens for other major cardiovascular risk factors [13].....