In this editorial for Asian session of June issue of Hypertension Research, we introduce two original papers, one review and one brief report.

Recently, literatures on blood pressure (BP) lowering effect of renal denervation (RDN) have been increasingly accumulated [1, 2]. Recent metaanalysis of 9 randomized sham-controlled trials demonstrated the significantly BP lowering effect on office and 24-hr ambulatory BP in both unmedicated and/or medicated hypertensive patients [1]. However, BP lowering effect is evaluated 2–3 months after the RDN procedure in these clinical trials, and long-term follow-up data has been limited especially in Asia. In this issue, Panchavinnin P et al. reported much longer-term outcome of RDN up to nearly 9 years in Thailand [3], and confirmed that the BP lowering effect of RDN greater than 10 mmHg for systolic office BP was sustained up to nearly nine years in the medicated patients with resistant hypertension. This result is consistent with the previous papers of Kario K, et al. [4], and of Kim BK [5], et al. which demonstrated the marked BP lowering effect on office BP at 36 months after RDN. The longer-follow up data of 24-hr BPs in the SPYRAL-HTN On-Med trial has been just released in the Lancet [6]. This study demonstrated the all the 24-hr, morning, and nighttime systolic BPs were more significantly reduced by 10 mmHg or more in the RDN group than in the Sham-controlled group in medicated hypertensive patients. In our recent results of the JAMP study using ambulatory BP monitoring [7], and of the J-HOP study using home BP monitoring [8], both demonstrated that drug-resistant hypertensive patients with uncontrolled 24-hr systolic BP ≥ 130 mmHg or home systolic BPs ≥135 mmHg exhibited the poor cardiovascular prognosis in the patients with resistant hypertension. Asians are more likely to exhibit masked hypertension such as morning and nocturnal hypertension than Westerners [9]. In Asia, long-term BP lowering effect of RDN on BPs during 24-hrs including morning and nighttime indicate that RDN will effectively reduce the cardiovascular events.

Another interested paper on RDN was written by Zhang Z et al. from China [10]. The paper presents the results of survey using questionnaire on patient preferences for renal denervation (RDN) therapy as a therapeutic option of hypertension. The result is consistent with the reports of Kario et al. from Japan [11], and of Schmieder from Germany [12]. It seems that Chinese, Japanese, European hypertensive patients has similar preference of the RDN therapy. Patient-centered hypertension management considering patient preference will extensively increase the BP control rate, resulting in reduction of cardiovascular events. Recently, European and US experts released the position papers of RDN [13, 14]. The Asia Renal Denervation Consortium (ARDeC), and each Asian country released the position papers in Asia [15, 16]. The RDN will have significant positioning in Asian management of hypertension in near future.

Salt restriction has always been an important factor for lowering BP and prevent cardiovascular evens and organ damages. Especially, high salt intake is the big problem in Asia [17]. Ohashi et al. showed annual changes in plasma brain natriuretic peptide (BNP) levels were associated with salt intake in the general population [18]. BNP is the important biomarker of cardiac stress, which indicate the risk of heart failure, atrial fibrillation, stroke, and coronary artery disease [9]. The cardiovascular risk of BNP is partly mediated by nocturnal hypertension [19], which is residual risk for stroke and heart failure [20, 21].

Kitagawa writes a state-of-art review and stress the importance of more strict BP control for the secondary prevention of stroke [22], based on the results of RESPECT study and metaanalysis [23, 24]. Asians are more likely to develop stroke, especially hemorrhagic stroke, which is more closely associated with hypertension than Westerners [9]. Taken together with the recent results of STEP study which demonstrate the benefit of BP control <130 mmHg in older Chinese hypertensive patients [25], strict BP control seems extremely important for both primary and secondary prevention of cardiovascular events in Asia.

In conclusion, the papers in this special issue indicate the importance of salt restriction, strict 24-hr BP control, and RDN in Asia (Fig. 1) and they are on the same global direction of the latest hypertension researches [26].

Fig. 1
figure 1

Importance of salt restriction, strict 24-hr blood pressure control, and renal denervation in Asia

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