Ambulatory Blood Pressure Monitoring in Lean, Obese and Diabetic Children and Adolescents

Abstract

Aim: To determine if children and adolescents who have obesity (Ob) or type 2 diabetes (T2DM) of relatively short duration have impaired cardiovascular function compared with lean subjects using 24-hour ambulatory blood pressure as a surrogate measure of evaluation. Methods: We enrolled 100 African-Caribbean subjects (45 males/55 females), mean ages 14.4-15.2 years (range 11.8-18.5 years) and Tanner stage 4.2-4.8. Mean BMI for the Ob (n = 40), T2DM (n = 39) and lean (n = 21) groups were 40.3, 34.2 and 20.8, respectively (p < 0.01, Ob and T2DM vs. lean). Mean hemoglobin A1c in lean and Ob was 5.4 and 5.5% compared to 8.8% in T2DM (p < 0.001, T2DM vs. lean and Ob). Ambulatory blood pressure was recorded every 20 min over 24 h using Spacelabs 70207. Results: Mean 24-hour, daytime and nighttime systolic blood pressure was significantly higher in Ob and T2DM compared with lean subjects (mean 24-hour 117 and 120 vs. 109 mm Hg; daytime 121 and 123 vs. 113 mm Hg; and nighttime 109 and 115 vs. 101 mm Hg; p < 0.01 for all time periods). The nocturnal systolic dip in Ob and T2DM did not differ from that of lean, whereas nocturnal diastolic dip decreased significantly in Ob and T2DM compared to lean (11.5 and 10.4 vs. 20.6 mm Hg; p < 0.01). Mean pulse pressure was significantly increased in the Ob and T2DM groups compared to lean subjects (51 and 54 vs. 45 mm Hg; p < 0.01). Conclusion: Adolescent Ob and T2DM groups share adverse risk factors, which may be harbingers of adult cardiovascular events.

Ambulatory Blood Pressure and Arterial Stiffness in Obese Children and Adolescents

“…The 24-hours nocturnal SBP reduction was significantly lower in obese subjects compared to controls. This finding is in agreement with the results published by Shikha [23]. For the mean nocturnal DBP reduction the difference was not significant as it was observed in the above mentioned study [23].…”

“…The nocturnal systolic dip decreased significantly in the obese children compared to controls; finding that is conflicting with the results of Shikha et al [23].…”

“…24-hour ambulatory BP measurements are wide used in children and adolescents. 24-hours BP monitoring is the most precise way to evaluate the BP burden [21] A positive association between obesity and high blood pressure in children and adolescents was demonstrated by numerous studies [21][22][23] The ambulatory BP, especially the systolic BP, was elevated in the obese patients. In our study the diurnal SBP was significantly increased in obese subjects, finding that is in opposition with the results of a recent study where nocturnal BP was increased in obese children and adolescents [21].…”

Insulin Resistance and β-Cell Function of Lean versus Overweight or Obese Filipino Patients with Newly Diagnosed Type 2 Diabetes Mellitus

“…The mean systolic and diastolic blood pressures of the overweight/obese group were also higher compared to the lean group. This was congruent to the study of Shikha et al, 34 that daytime, nocturnal and 24-hour mean systolic blood pressure were significantly higher in obese subjects. Obesity is known as a major risk for hypertension because it surges tubular reabsorption impairing pressure natriuresis resulting to volume expansion thru the activation of the renin-angiotensin system.…”

Ambulatory systolic blood pressure and obesity are independently associated with left ventricular hypertrophic remodeling in children

“…A few studies using ABP monitoring have shown a positive correlation between systolic BP and increased LVMI [ 13 – 15 , 20 ]. However, these studies either did not evaluate the independent effect of obesity [ 20 ], or were conducted on biased populations (children with casual hypertension [ 13 ], at risk for hypertension [ 14 ], or with other complications [ 15 ]). To our knowledge, no study has comprehensively investigated the relationship between obesity, ABP and measures of cardiac remodeling in otherwise healthy children.…”