Hot Topics in Hypertension - Editor-in-chief: Massimo Volpe

The disease burden associated with arterial hypertension is still very high today. Despite the evident progress in the diagnosis and treatment of hypertension and its cardiovascular and renal consequences that has been achieved over the last 30 years, the rate of growth of ischemic heart disease, stroke, congestive heart failure and chronic kidney failure continues to escalate worldwide. Several potential factors contribute to this worrisome situation, but the principal cause is most likely cardiorenal damage secondary to poor control of blood pressure. Thus, any progress in the therapeutic management of hypertension deserves our utmost attention.
In this light, this review by Barrios and co-workers is timely and appropriate. Starting from the core of the problem–the unmet need of control of hypertension and its increasing socioeconomic burden–the authors analyze the impact of cardiorenal involvement in hypertensive patients and focus on the importance of the pathophysiologic role of the renin-angiotensin system. They present strong evidence to support the case that blockade of the renin-angiotensin system should be considered a cornerstone of antihypertensive therapy. Not only does this approach achieve desirable blood pressure control, but it is now well documented that drugs that block the renin-angiotensin system have significant cardiorenal protective properties. Accordingly, the authors also discuss the most recent major clinical trials based on the use of angiotensin receptor blockers (ARBs).
Within this class of drugs the authors focus on olmesartan medoxomil, a molecule endowed with specific pharmacokinetic properties as well as with remarkable blood-pressure-lowering action and a good tolerability profile. They review in detail the clinical development of this ARB, revisiting several important studies, especially ones based on antihypertensive therapy, and they also report interesting evidence of cardiac, vascular, and renal protection by olmesartan in hypertension and diabetes.
The review is up to date and well written, and I am confident that physicians everywhere will find this work of great help in obtaining important clinical information on the general problem of cardiorenal protection in hypertension and on the specific clinical profile of olmesartan medoxomil.