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ACE inhibitors appear to be more effective than beta blockers or calcium channel blockers in preserving kidney function and preventing kidney disease in patients with high blood pressure. This is important because chronic high blood pressure can damage the kidneys. A study of 1,094 African Americans also found that any degree of blood pressure lowering is beneficial.

The association of borderline hypertension (blood pressure elevated above normal, but not dramatically so) with risk factors for cardiovascular disease is being studied in an ongoing project in Tecumseh, Michigan. Results from 946 healthy subjects (124 borderline, 822 normotensive) aged 18 to 38 years are presented. Blood pressure (BP), cardiac output (the volume of blood pumped by the heart), minimal forearm resistance (a measure of the resistance offered to blood flow by thicker blood vessels), levels of various substances in the blood, and body weight were evaluated for all subjects. Borderline hypertension was defined as exceeding 140 mm Hg systolic (during the heart's contracting phase) and/or 90 mm Hg diastolic (during the resting phase), when BP was measured in the clinic. Results showed that the borderline hypertension group had higher heart rates, lower stroke volume (amount of blood pumped with each heartbeat), and elevated vascular resistance and minimal forearm vascular resistance (indicating less compliant vessels). Other heart disease risk factors, such as blood cholesterol levels, were greater for this group. These subjects were an average of 29 pounds heavier than subjects in the normotensive group. Skinfold thickness (a measure of fat deposition under the skin) was higher in the borderline hypertensive group. This and other correlations between BP and cardiovascular risk factors were due to hypertensive subjects tending to be overweight. Longitudinal analysis showed that adults with borderline hypertension had had higher BP in the first decade of life than normotensive subjects. The difference intensified at the age of 21. Even if they had thicker skinfolds, subjects who had had normal BP at age six did not tend to develop hypertension. On the other hand, half of the children with higher BP, but normal skinfolds, became borderline hypertensive as adults. Borderline hypertensives had a family history of higher BP. The results show that borderline hypertension begins in childhood, and that it is associated with several risk factors for heart disease. Identification of people with this potentially dangerous condition should lead to earlier intervention. (Consumer Summary produced by Reliance Medical Information, Inc.)

The ACE inhibitor ramipril may slow the progression of kidney disease in African-Americans who have hypertension. This was the conclusion of a study of 1,094 African-Americans who had hypertensive kidney disease.

The authors comment on a study published within the issue on hypertension as an emerging risk factor for acute heart failure (AHF) in Africa. Findigs showed that although the best treatment strategy for AHF among patients of African descent remains controversial, the study demonstrates that the optimal strategy to prevent AHF is the treatment of hypertension. Concurrent increase in obesity also suggests that lifestyle factors are driving the increasing incidence of AHF.