Volume 11 Issue 4, April 2014

The Eighth Joint National Committee (JNC 8) guidelines on hypertension have generated great interest among physicians. These guidelines differ from those published in 2003 (the JNC 7)—in the document format, blood-pressure cut-off values, and recommendations for antihypertensive drug use. The JNC 8 have some limitations that could affect clinical practice.

The coronary collateral circulation protects the myocardium when blood flow is reduced because of an occlusion. In this Review, Zimarino and colleagues discuss the development of collateral vessels through tissue remodelling. Collaterals and their underlying adaptative mechanisms are clinically important to modern interventional cardiology.

The term 'athlete's heart' refers to the plethora of electrical, structural, and functional cardiac adaptations that occur in athletes undertaking vigorous training regimens. The manifestations of cardiac adaptation to exercise can resemble the signs of cardiac disease that precede sudden cardiac death. Differentiation between athlete's heart and cardiac pathology presents a challenge for physicians. In this Review, Sheikh and Sharma describe the impact of ethnicity on cardiac adaptation to exercise, with a focus on black athletes, and discuss the impact of ethnically mediated changes on preparticipation cardiovascular evaluation.

The prevalence of calcific aortic valve disease (CAVD) is increasing as the global population ages. In the absence of a specific drug therapy, the only treatment for CAVD is valve replacement. In this Review, Hutcheson et al. discuss the mechanisms of CAVD and identify potential therapeutic targets that warrant further investigation.

The use of multipotent stem cells to achieve regeneration in cardiovascular disease has been the subject of continuous evaluation over the past decade. Dr Behfar and colleagues review experience obtained from trials of 'first-generation' cell-based therapy, and discuss the advances that have enabled the development of 'next-generation' stem-cell-based therapies targeting cardiovascular disease.