In this first editorial of 2010 and as the European Society of Hypertension (ESH) prepares for what promises to be a fantastic ESH meeting in Oslo we consider what this year might herald for hypertension and cardiovascular risk prevention. It is a real pleasure to reveal that a record number of over 1770 abstracts have been submitted for the Oslo meeting and there are many exciting satellites scheduled that will cover important developments in hypertension and cardiovascular care. We wish to thank the membership and the scientific teams who work with them for their tremendous response. 

Identifying genes influencing blood pressure

In the past few years we have started to identify the genes for common cardiovascular diseases and in the initial series of publications it was clear that elucidating the genetic architecture of blood pressure was very challenging. In May 2009 two papers in Nature Genetics described 13 genes with modest effect on blood pressure and hypertension from large-scale meta-analysis of genome scans ^1,2 . It seems that the circuit diagram of blood pressure regulation proposed years ago by Arthur Guyton that highlighted the complexity of the determination of blood pressure level is now ready to be populated with the real aetiological factors. Over the course of this year we anticipate new findings progressing our understanding of the genes underpinning blood pressure and hypertension. Hopefully this understanding could translate into new treatment modalities in the future, time will tell. 

Novel therapeutic strategies for hypertension

Last year in the Lancet and at the Milan ESH meeting the intriguing results of an observational cohort study on renal sympathetic denervation in resistant hypertension were presented ^3,. This adapted catheter based technologies used for ablation therapy in atrial fibrillation for use on the endothelial wall of the renal artery. Initial data showed promising effects on renal sympathetic outflow and importantly blood pressure lowering in individuals previously thought to be somewhat resistant to therapy. This year data on longer term follow up of this cohort should be available and a separate ongoing randomised controlled trial of this therapy in resistant hypertension will complete enrolment. 

Reducing the risk of chronic kidney disease progression.

The Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial of 11,506 patients showed that initial treatment for high blood pressure with benazepril plus amlodipine was superior to benazepril plus hydrochlorothiazide in reducing cardiovascular disease and mortality ⁴. New data from this study, published in the Lancet, examined the effect of these drug combinations on progression of Chronic Kidney Disease. There was a small but significant difference in progression to chronic Kidney disease the benazepril plus amlodipine group (2%) compared with in the benazepril plus hydrochlorothiazide group 3·7%. This fits with the previous report of enhanced endpoint reduction in the benazepril plus amlodipine group ⁵. 

The ESH is committed to improving hypertension care

This year we anticipate the reports from the ROADMAP, ACCORD-BP, ACCORD-Lipids and other studies which will further enhance our knowledge of how best to prevent cardiovascular disease in our patients. The ESH is committed to identifying gaps in the evidence and has been working on trial design of key European-wide studies which we believe will allow us to fully engage ESH Excellence Centres, their affiliated blood pressure clinics and most importantly their patients. These trials will enable those treating hypertension to better address unmet need in cardiovascular prevention. In that pursuit the ESH council has issued a call to ESH Excellence Centres to scope their interest in engagement in these important trial programmes. The ESH Council recognises that there may be considerable expertise in hypertension and cardiovascular clinics which are not Excellence Centres and we now encourage any clinics who would like to be part of these studies to get in touch with their nearest ESH Excellence Centre (see web link for ESH Excellence Centres). One target group for a new intervention trial could be elderly patients with a systolic blood pressure in the range of 140-160 mmHg, as this category of patients was not included in the HYVET trial. 

We welcome all new and old members of the ESH to support our efforts to advance strategies to counteract the detrimental influence of hypertension on public health, not only in Europe but on a global scale! 

• 1. Newton-Cheh C., et al. Eight blood pressure loci identified by genome-wide association study of 34,433 people. Nature Genetics 2009; 41:666-676.
• 2. Levy D., Ehret G.B., Rice K. et al. Genome-wide association study of blood pressure and hypertension. Nat Genet. 41:677-87 (2009).
• 3. Schlaich MP, Sobotka PA, Krum H, Lambert E, Esler MD. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med. 2009 Aug 27;361(9):932-4.
• 4. Jamerson K, Weber MA, Bakris GL, Dahlöf B, Pitt B, Shi V, Hester A, Gupte J, Gatlin M, Velazquez EJ; ACCOMPLISH Trial Investigators. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008 Dec 4;359(23):2417-28.
• 5. Bakris G. et al. Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial. Lancet, Early Online Publication, 18 February 2010 doi:10.1016/S0140-6736(09)62100-0 .