Editorial [ Pathophysiological Basis For New Frontiers in Arterial Hypertension Guest Editor: A. Nitenberg ]

Arterial hypertension is an important cause of morbidity and mortality because arterial hypertension is not only an abnormal increase of arterial pressure, it is also accompanied by a number of concomitant disorders. More than a "silent killer", high blood pressure is a "time bomb" because patients who can feel great and have high blood pressure are exposed to stroke, myocardial infarction, heart failure and kidney failure. Prevalence of arterial hypertension in the world in adult population was about 26.6% in men and 26.1% in women in 2000, that corresponds to 1 million individuals with considerable disparities between developed countries and other countries, especially for the complications, due both to diagnostic failure and absence of therapy. Projections estimate that this number would increase by 60% in 2025, mainly due to the increase in food intake that should dramatically increase the prevalence of diabetes, metabolic syndrome and obesity, three important causes of arterial hypertension in developed countries and in emergent countries with an expected increase of respectively 25% and 80% of arterial hypertension in 2025. Arterial hypertension is a frequent disease that induces an important amount of research activity and a constant flow of knowledge and findings. Although the understanding of the factors involved in the pathophysiology of arterial hypertension has increased, which include neuro-endocrine factors, vascular and endothelial functions, autocrine and paracrine functions, interrelationships between target organ functions, metabolic disorders, genetic factors, primary (essential) hypertension remains a blanket that recovers our ignorance. Although important progress have been made in the treatment in arterial hypertension these last years in western countries, and although we have very efficient compounds to reach the goals of pressure values, the best statistics show that only about 50% of the known hypertensive are correctly treated. Moreover, even in patients correctly treated, the risk of complications remains higher than in normotensive patients showing the reduction of arterial pressure is only a part of the treatment. Thus, the challenge for the next years is not only the improvement of our means to reach the goal of "normal" pressure in hypertensive patients, it is also the prevention of target organs from deterioration due to the disease which does nor resume in an elevated pressure. This important objective will be reached only if our knowledge of pathophysiology of the disease(s) increases. With the assistance of the writers who have helped to produce this issue, it is possible to examine the most relevant aspects of arterial hypertension in a detailed and, I hope, a clear and accessible manner. The papers published in this issue try to provide pathophysiological informations that may be useful for the comprehension of arterial hypertension and its complications, and that also could be useful for the development of new therapeutic interventions that are not only pharmalogical.