Endothelin receptor antagonists (ERA) in hypertension and chronic kidney disease: A rose with many thorns

The discovery of endothelin created a lot of enthusiasm and paved new therapeutic avenues for the treatment of arterial hypertension. Endothelin plays a significant role in blood pressure regulation through pronounced vasoconstriction and modulation of sodium and water reabsorption in the kidneys. Endothelin receptor antagonists have been tested in many clinical trials in patients with arterial hypertension, heart failure, pulmonary arterial hypertension, systemic sclerosis, chronic kidney disease, and diabetic nephropathy. However, the results were usually disappointing, except in pulmonary hypertension and scleroderma digital ulcers. The future of ERAs for the treatment of arterial hypertension and chronic kidney disease does not seem bright, and only the combination with other classes of antihypertensive drugs might offer a way out

The emergence of ambulatory measurement of arterial stiffness and central blood pressure: A promising novelty of clinical importance or just another marker?

Whereas brachial blood pressure (BP) is still considered the gold standard for the estimation of cardiovascular risk in all clinical trials and guidelines, scientific interest is shifting towards central hemodynamics and the scientific community is experiencing a whole new revolution with the emergence of novel cardiovascular markers such as the ambulatory measurement of central BP and arterial stiffness. Central BP has already started to demonstrate its superiority over peripheral BP as a better and more reliable predictor of end-organ damage in cardiovascular diseases. Furthermore, ambulatory measurement of central BP and pulse wave velocity are expected to add much more useful information towards a more integrated assessment of cardiovascular risk and profile. However, more research is required before these novel markers could be incorporated in the everyday practice of BP measurement