Issue 3, 2009October 2, 2009 Welcome to the third issue of Kidney and Blood Pressure Research Digest (KBPR Digest). We would again like to draw your attention to articles of outstanding importance in the field of nephrology and hypertension and therefore present short summaries of these articles to the scientific community in the form of KBPR Digest. KBPR Digest provides readers from all over the world with a free and concise overview on interesting topics which are part of the current issue of Kidney and Blood Pressure Research. We hope that you will be inspired to get to know more about the details of the articles which are discussed below. Professor Thomas Quaschning, MD, PHD In behalf of the Editorial Board of Kidney and Blood Pressure Research mail@thomas-quaschning.de   Digest of issue 4/2009 Issue 4/2009 of Kidney and Blood Pressure Research covers a wide spectrum of clinical and preclinical topics. It contains a study which explores arterial stiffness as a predictor for cardiovascular mortality in hemodialysis patients as well as an evaluation of the combination treatment with olmesartan and azelnidipine in murine polycystic kidney disease. A third study directly compares the effect of ace inhibitors versus angiotensin receptor blockers in hypertensive patients with diabetic nephropathy. Increasing attention is being paid to the predictors of cardiovascular mortality in hemodialysis patients. In previous studies, different parameters of arterial stiffness were related to cardiovascular mortality, but their relative prognostic value has not previously been evaluated in one cohort of hemodialysis patients. El Hadj Othmane and coworkers (Kidney Blood Press Res 2009;32:250-257) measured carotid-femoral pulse wave velocity (PWV), carotid augmentation index, carotid pulse pressure and carotid-brachial pulse pressure amplification (AMP) in a cohort of 98 patients before and after hemodialysis. Patients were followed for a median of 29 months and the association of these parameters with cardiovascular mortality was assessed using log-rank tests and Cox proportional hazard regressions. During follow-up, 25 patients died of cardiovascular causes. Increasing pre- and postdialysis PWV tertiles and decreasing predialysis AMP tertiles were significantly related to cardiovascular mortality. In contrast, neither carotid augmentation index nor carotid pulse pressure was related to cardiovascular mortality. These findings suggest that PWV is a stiffness parameter that adds significant prognostic information to established risk factors when assessing cardiovascular mortality risk. Indeed, the present "European Society of Hypertension and European Society of Cardiology Guidelines on Hypertension Management" consider PWV as a marker of subclinical organ damage that may be useful for physicians to evaluate total cardiovascular risk. Combination treatment with an angiotensin receptor blocker (ARB) and a calcium channel blocker (CCB) is effective against vascular disease, including ischemic brain damage, is more efficient in improving urinary albumin excretion than ARB monotherapy. On the other hand, previous reports indicated that interstitial inflammation plays a role in the development of polycystic kidney disease (PKD), and that Ang II, which is partly produced by tubular cells and infiltrating leukocytes, induces cellular activation by upregulating adhesion molecules and chemokines. It was recently reported that ARB offer better renoprotective effects than CCB in PKD. However, the effects of their combination have not been examined in this disease so far. The present study by Japanese scientists (Kidney Blood Press Res 2009;32:239-249) evaluated the effects of combination treatment with olmesartan and azelnidipine in a mouse model for PKD and highlights its mechanisms. DBA/2-FG pcy mice were divided into the following groups: olmesartan treatment alone, azelnidipine treatment alone, combination treatment, or untreated. Olmesartan decreased the numbers of angiotensin II and gp91-positive cells, mainly macrophages, and cyst size at 4 weeks. However, only combination treatment suppressed cell infiltration, extracellular signal-regulated kinase activation and interstitial fibrosis with a significant change in the kidney weight/body weight ratio. The authors conclude that combination treatment with ARB and CCB protects against cyst enlargement in PKD by suppressing interstitial inflammation, fibrosis and oxidative stress by upregulating eNOS expression during disease course. These findings support the hypothesis that combination treatment with ARB and CCB has more beneficial effects on cyst enlargement than either monotherapy and may encourage future studies on the treatment of PKD. Diabetic nephropathy (DNP), being one of the most prevalent and problematic causes of end-stage renal disease (ESRD) worldwide, is an important concern in the routine nephrology practice. Renin-angiotensin-aldosterone system activation and especially angiotensin II has an important role in its hemodynamic pathophysiology. Glomerular damage resulting in urinary protein leakage exacerbates the progression of DNP. Managing DNP through blockade of the renin-angiotensin system is expected to have beneficial effects over and above those derived from systemic blood pressure lowering, since glomerular hypertrophy and intraglomerular hypertension have an important role in the progression of DNP. On the other hand, progression of DNP has been shown to be reduced with antihypertensive treatment. Until now, there is no study available that has directly compared angiotensin-converting enzyme inhibitor (ACEI) with angiotensin receptor blocker (ARB) in hypertensive patients suffering from overt DNP. Ozturk and coworkers (Kidney Blood Press Res 2009;32:268-275) analyzed the outcome of hypertensive patients with overt type 2 DNP and an estimated creatinine clearance < 90 ml/min treated with only ACEI or ARB. A total of 100 patients were included in the study. Mean duration of follow-up was 24.6 +/- 14.1 months. Renal function and proteinuria of both groups did not show any significant changes during follow-up. Blood pressure courses were also similar. Although the mean doubling time of creatinine in the ARB group was shorter than in the ACEI group, it was not statistically significant. Even though the study has several limitations such as the small number of patients, the authors demonstrated that ACEI and ARB have similar outcomes in overt DNP. Their renoprotective effects could be observed despite the ongoing hypertension. In direct comparison, both agents reduced proteinuria and showed beneficial effects in the preservation of renal function. Large scale comparative clinical trials may be necessary to disclose distinct differences between effects of ACEI and ARB in the treatment of DNP.   Congress Calendar ASN Renal Week 2009 San Diego, Calif., October 27-November 1, 2009 WCH 2009 World Hypertesion Congress Beijing, October 29-November 1, 2009 In conjunction with The 11th International Symposium on Hypertension and Related Diseases 2nd International Conference on Fixed Combination in the Treatment of Hypertension, Dyslipidemia and Diabetes Mellitus Valencia, December 10-12, 2009 9th Genoa Meeting on Hypertension, Diabetes and Renal Diseases Genoa, February 25-27, 2010 ESH 2010 20th European Meeting on Hypertension Oslo, June 18-22, 2010 23rd Scientific Meeting of the International Society of Hypertension Vancouver, September 26-30, 2010   © S. Karger AG - Medical and Scientific Publishers Allschwilerstrasse 10, P.O. Box, CH-4009 Basel (Switzerland) Tel. +41 61 306 1200, Fax +41 61 306 1234, publications@karger.com. 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