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Predictive medicine, pathophysiology and therapeutics.

DOI:10.1097/HJH.0000000000000305 N ew studies searching for markers predictive of mortality and morbidity in hypertension are published in this issue of the Journal of Hypertension. Strandberg et al. (pp. 1797–1804) report the findings from the prospective Helsinki Businessmen Study, showing that lower blood pressure (BP) in midlife is associated with longer life (a substantial 7.5-year age-adjusted difference in the mean survival between men with normal BP and men with SBP at least 160 mmHg or DBP at least 100 mmHg) and better physical functioning and general health-related quality of life in old age. Cuspidi et al. (pp. 1879–1887) have analysed the data from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) prospective population study with a follow-up of 148 months and found that aortic root diameter (as assessed by echocardiography) indexed to height is predictive of the incident nonfatal and fatal cardiovascular events, and support that assessment of the aortic root diameter in addition to left ventricular mass may refine cardiovascular risk stratification and preventive strategies in the general population. In a cross-sectional study measuring 24-h aortic and brachial BP, Protogerou et al. (pp. 1805–1814) found a higher discriminatory ability of 24-h average aortic than brachial SBP to detect the presence of left ventricular hypertrophy. In an accompanying comment, Salvi et al. (pp. 1774–1777) discuss the reliability of central BP and explain why recent European Society of Hypertension/European Society of Cardiology hypertension guidelines [1] did not recommend the routine clinical measurement of central BP. Furthermore, in this same issue of the journal a systematic review and meta-analysis of the recent studies comparing central and brachial SBP shows that noninvasive estimation of central BP is device and technique dependent, and the authors call for caution in applying these devices and techniques across the clinical studies (Narayan et al., pp. 1727–1740). In a prospective study of pregnant women, Chen et al. (pp. 1833–1841) found that foetal and maternal plasma angiotensin (1–7) concentrations were independently associated with preterm birth, a known risk factor for hypertension later in life. Indeed, another article in this issue, using data from the Avon Longitudinal Study of Parents and Children (Howe et al., pp. 1789–1796), confirm that small size at birth followed by rapid adiposity gain in infancy and continued overweight or obesity are associated with high BP in young adulthood, thus emphasizing the importance of maintaining normal weight in childhood for the prevention of high BP. Finally, the association of hypertension prevalence with socioeconomic inequalities is illustrated in a comprehensive epidemiological study in Iran (Fateh et al., pp. 1782–1788).