This issue of the Medical Clinics of North America brings the practicing clinician up to date on the current challenges, new concepts, and management of hypertensive disease. Topics covered include risks in hypertension; new biological concepts of target organ involvement in hypertension; hypertension and the metabolic syndrome; aging versus hypertension; hypertension, systolic blood pressure, and large arteries; oxidative stress, endothelial dysfunction, and hypertension; current thinking about hypertensive heart disease; diastolic dysfunction as a link between hypertension and heart failure; hypertension and cardiac failure in its various forms; hypertension and atherogenesis; the kidney, hypertension, and remaining challenges; current thinking about renovascular hypertension; obesity and hypertension; and barriers to adherence in hypertension management.

This issue of Medical Clinics, guest edited by Dr. Edward Frohlich, is devoted to Hypertension. Articles in this outstanding issue include The Kidney in Hypertension; Heart: Fibrosis, Apoptosis, and Cardiac Failure; Myocardial Ischemia; Oxidative Stress and Hypertensive Diseases; Adherence to Antihypertensive Therapy; Aging and Hypertension; Target Organs and Microbiological Considerations in Hypertensive Diseases; Obesity and Sodium Considerations; Diabetes, Hypertension and Cardiorenal Syndrome; Renal Arterial Disease; Cardiac Transplantation and Hypertensive Diseases; Cardiac Failure: Old and New Challenges; Diastolic Dysfunction and Hypertension; Stiffening of Large Arteries; Genetics and Mechanisms; New Guidelines for Hypertensive Diseases; and Local Renin Angiotensin Systems.

Until recently, the renin-angiotensin-aldosterone system has been considered a systemic endocrine hormonal system exclusively. It is now known that each component of the renin-angiotensin system is produced, synthesized and indeed, present in many organisms including the heart and vessels. This volume presents the most recent clinical and laboratory experiences of the leading physicians and investigators in the field of the local cardiac renin-angiotensin aldosterone system. Cardiovascular, renal and hypertension oriented physicians, investigators and scientists would find this book of interest. Edward D. Frohlich, M.D., M.A.C.P, F.A.C.C., is the Alton Ochsner Distinguished Scientist at the Ochsner Clinic Foundation in New Orleans, Louisiana. He is also Professor of Medicine and of Physiology at Louisiana State University School of Medicine, New Orleans, and Clinical Professor of Medicine and Adjunct Professor of Pharmacology at Tulane University School of Medicine, New Orleans. He is past Editor-in-Chief of the American Heart Association journal HYPERTENSION. Richard N. Re, M.D., is the Section Head, Hypertension at the Ochsner Clinic Foundation in New Orleans, Louisiana. He is also Ochsner's Scientific Director of Research.

In cardiovascular prevention, there is classically a small number of cardiovascular risk factors to treat, such as hypertension, diabetes, hyperlipidemia and smoking excess, which are widely detected and treated. Recently, it has been widely recognized that new mechanical factors should be detected and treated and involves specifically pulsatile arterial hemodynamic (PAH) parameters such as: arterial stiffness, pulse pressure, and, to a lesser extent, augmentation index and pulse pressure amplification. The pedagogic aspect of this new CV specialty involves 3 principal parts: a. -Basic concepts and pathophysiological mechanisms of PAHb. -Clinical aspects and end-organ damage in PAHc. - Clinical pharmacology and therapeutics of PAH This book represents the first that spans basic science and clinical management of this new CV subspecialty. Much has been learned regarding the management of these patients in recent years and this book presents extensive data on the techniques needed to maximize outcomes.

Experimental and clinical evidence supports the view that the activation of the renin angiotensin aldosterone system is involved in cardiovascular pathology including hypertension, heart failure, myocardial ischemia, and atherosclerosis. The present volume describes the intricacies involved in these processes, including the in?uence of prorenin/renin, angiotensin II, angiotensin (1-7), and aldosterone on cardiac and vascular functions as well as their involvement in the generation of cardiovascular diseases. Fundamental aspects like intracellular signaling, regulation of cell volume in the failing heart, and the presence of an intracrine renin angiotensin system are discussed. Moreover, the role of the mineralocorticoid receptor as an important c- ponent of the intracrine renin angiotensin system and as a regulator of extracellular action of angiotensin II is described, reinforcing the view that aldosterone inhibitors are helpful in the treatment of heart failure and hypertension. Let us hope the imp- tant topics included here motivate basic and clinical investigators and contribute to the development of new therapeutic approaches for cardiovascular diseases. We want to thank the distinguished authors and Humana Press for the opportunity to publish this important book. Walmor C. DeMello Edward Frohlich v Contents 1 Systemic Versus Local Renin Angiotensin Systems. An Overview ...1 Walmor C. DeMello and Richard N. Re 2 Clinical Import of the Local Renin Angiotensin Aldosterone Systems ...7 Edward D. Frohlich 3 Renin, Prorenin, and the (Pro)Renin Receptor ...15 Genevieve Nguyen and Aurelie Contrepas 4 Local Renin Angiotensin Systems in the Cardiovascular System ...25 Richard N.

Until recently, the renin-angiotensin-aldosterone system has been considered a systemic endocrine hormonal system exclusively. It is now known that each component of the renin-angiotensin system is produced, synthesized and indeed, present in many organisms including the heart and vessels. This volume presents the most recent clinical and laboratory experiences of the leading physicians and investigators in the field of the local cardiac renin-angiotensin aldosterone system.

Cardiovascular, renal and hypertension oriented physicians, investigators and scientists would find this book of interest.

Edward D. Frohlich, M.D., M.A.C.P, F.A.C.C., is the Alton Ochsner Distinguished Scientist at the Ochsner Clinic Foundation in New Orleans, Louisiana. He is also Professor of Medicine and of Physiology at Louisiana State University School of Medicine, New Orleans, and Clinical Professor of Medicine and Adjunct Professor of Pharmacology at Tulane University School of Medicine, New Orleans. He is past Editor-in-Chief of the American Heart Association journal HYPERTENSION.

Richard N. Re, M.D., is the Section Head, Hypertension at the Ochsner Clinic Foundation in New Orleans, Louisiana. He is also Ochsner's Scientific Director of Research.

Experimental and clinical evidence supports the view that the activation of the renin angiotensin aldosterone system is involved in cardiovascular pathology including hypertension, heart failure, myocardial ischemia, and atherosclerosis. The present volume describes the intricacies involved in these processes, including the in?uence of prorenin/renin, angiotensin II, angiotensin (1-7), and aldosterone on cardiac and vascular functions as well as their involvement in the generation of cardiovascular diseases. Fundamental aspects like intracellular signaling, regulation of cell volume in the failing heart, and the presence of an intracrine renin angiotensin system are discussed. Moreover, the role of the mineralocorticoid receptor as an important c- ponent of the intracrine renin angiotensin system and as a regulator of extracellular action of angiotensin II is described, reinforcing the view that aldosterone inhibitors are helpful in the treatment of heart failure and hypertension. Let us hope the imp- tant topics included here motivate basic and clinical investigators and contribute to the development of new therapeutic approaches for cardiovascular diseases. We want to thank the distinguished authors and Humana Press for the opportunity to publish this important book. Walmor C. DeMello Edward Frohlich v Contents 1 Systemic Versus Local Renin Angiotensin Systems. An Overview ...1 Walmor C. DeMello and Richard N. Re 2 Clinical Import of the Local Renin Angiotensin Aldosterone Systems ...7 Edward D. Frohlich 3 Renin, Prorenin, and the (Pro)Renin Receptor ...15 Genevieve Nguyen and Aurelie Contrepas 4 Local Renin Angiotensin Systems in the Cardiovascular System ...25 Richard N.