Insulin resistance, prehypertension, hypertension and blood pressure values in paediatric age

Genovesi, Simonetta; Brambilla, Paolo; Giussani, Marco; Galbiati, Susanna; Mastriani, Silvana; Pieruzzi, Federico; Stella, Andréa; Valsecchi, Maria Grazia; Antolini, Laura

doi:10.1097/hjh.0b013e32834e4aaa

Cited by 35 publications

(28 citation statements)

References 47 publications

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“…6 Furthermore, by gathering data on SUA and insulin sensitivity, we were able to investigate the independent role of these 2 traditionally entangled factors on the rise in BP in children at risk. Our results indicate that future arterial pressure is mainly predicted by SUA levels even independently of insulin homeostasis and weight variations, suggesting that previous cross-sectional studies reporting an association between adiposity, hyperinsulinemia/metabolic syndrome, and hypertension in adolescents [17][18][19] were showing only part of the complex pathogenetic mechanisms of BP modulation in children.…”

Section: Discussionmentioning

confidence: 49%

Increased Serum Uric Acid Levels Blunt the Antihypertensive Efficacy of Lifestyle Modifications in Children at Cardiovascular Risk

et al. 2016

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P rimary hypertension is a growing concern in children and adolescents in western countries largely because of its association with the ongoing obesity epidemic. Elevated serum uric acid (SUA) levels are frequently found in children with hypertension and obesity.1 Although primary hypertension in children was initially thought to reflect the underlying presence of subtle renal damage and insulin resistance, recent epidemiological and experimental data support the hypothesis that SUA may play an independent pathogenetic role in the early stages of vascular damage and the subsequent development of hypertension.2 Moreover, hyperuricemia has been associated with increased risk of hypertension development in adults in a large number of studies published to date. [3][4][5] Among participants in the Bogalusa Heart Study, SUA levels measured during childhood and greater changes in SUA from youth to adulthood were significant predictors of adult blood pressure (BP) values.6 Accordingly, recent meta-analyses indicate that high SUA levels entail an increased risk of hypertension incidence 7 with a consistent dose-response relationship, which supports causal disease-exposure association. have consistently been demonstrated to induce significant increases in SUA levels. In this context, SUA is emerging as a potentially modifiable risk factor for the prevention and treatment of hypertension. In fact, a reduction in SUA levels has been shown to prevent the development of hypertension in animal models, 10,11 and preliminary clinical trials indicate a BP-lowering effect of SUA reduction by either xanthine See Editorial Commentary, pp 845-847Abstract-Primary hypertension is a growing concern in children because of the obesity epidemic largely attributable to western lifestyles. Serum uric acid is known to be influenced by dietary habits, correlates with obesity, and could represent a risk factor for hypertension. Preliminary studies in children highlighted uric acid as a potentially modifiable risk factor for the prevention and treatment of hypertension. The effect of lifestyle changes (increase of physical activity and dietary modifications) on blood pressure values, weight status, and serum uric acid levels in a cohort of 248 children referred for cardiovascular risk assessment were evaluated over a mean 1.5-year follow-up. At baseline, 48% of children were obese and 50% showed blood pressure values >90th percentile. At follow-up, a significant improvement in weight class (24% obese; P<0.0001) and blood pressure category (22% >90th percentile; P<0.0001) was found. Systolic blood pressure z-score (P<0.0001), uric acid value (P=0.0056), and puberty at baseline (P=0.0048) were independently associated with higher systolic blood pressure z-score at follow-up, whereas a negative association was observed with body mass index z-score decrease during follow-up (P=0.0033). The risk of hypertension at followup was associated with body mass index (P=0.0025) and systolic blood pressure (P<0.0001) z-score at baseline and inversely related t...

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Section: Discussionmentioning

confidence: 49%

Increased Serum Uric Acid Levels Blunt the Antihypertensive Efficacy of Lifestyle Modifications in Children at Cardiovascular Risk

et al. 2016

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“…However, we analyzed the relationship between UA and those parameters, such as eGFR and HOMA index, which, even in the range of normality, could be implicated in the development of hypertension in children. 13 Even slightly elevated serum UA levels have shown to be strong, independent predictors of the development of type 2 diabetes in adult cohorts of unselected general populations, 28 as well as of HT patients. 29,30 Moreover, recent data strongly support the hypothesis that insulin resistance in children might play a role in hypertension development regardless of obesity and fat distribution.…”

Section: Figurementioning

confidence: 99%

“…29,30 Moreover, recent data strongly support the hypothesis that insulin resistance in children might play a role in hypertension development regardless of obesity and fat distribution. 13 Other variables, such as puberty and renal function, 10,14 have also been shown to bear an influence on the link between UA and BP in children.…”

Section: Figurementioning

confidence: 99%

“…7 The complex interaction between serum UA, BP changes,andother well-established risk factors has been elucidated only in part, and controversy remains as to whether UA is an independent causal factor or merely a marker of the development of hypertension. 8 It has been suggested that several factors, such as age, 9 puberty, 10 obesity, 11,12 insulin resistance, 13 and impaired renal function, 14 all of which are related to UA levels, may play a role in the development of hypertension. In 2 recent trials, serum UA reduction by allopurinol or probenecid resulted in BP normalization in children and adolescents with increased BP levels, thus supporting a causative role for UA in hypertension.…”

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confidence: 99%

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Serum Uric Acid and Blood Pressure in Children at Cardiovascular Risk

Viazzi

Antolini

Giussani³

et al. 2013

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Uric acid (UA) is associated with hypertension in children, after body weight adjustment. Whether the whole spectrum of variables, such as visceral adiposity, insulin resistance, puberty, and renal function, influence the relationship between UA and blood pressure is unknown. WHAT THIS STUDY ADDS:In a cohort of children at relatively high cardiovascular risk, the association between UA and blood pressure levels is independent of several well-known factors implicated in the development of hypertension, such as insulin resistance, pubertal status, and renal function. abstract OBJECTIVES: Hyperuricemia has been shown to be a strong correlate of hypertension in children. However, the complex interaction between serum uric acid (UA), systemic blood pressure (BP), and possibly confounding factors has been elucidated only in part. METHODS:We evaluated office BP as well as clinical and biohumoral parameters in a cross-sectional cohort of 501 children (280 boys and 221 girls) aged between 6 and 18 years (mean = 10.8 years) consecutively referred for cardiovascular risk assessment. RESULTS:Overall, 156 (31.1%) were normotensive, 122 (24.4%) showed transient hypertension, 87 (17.4%) had prehypertension, and 136 (27.1%) had hypertension. Altogether 33.3% and 40.5% of the study group were overweight or obese, respectively. There was a trend toward greater weight and waist circumference and higher BMI, Homeostasis Model Assessment index, and UA levels as the BP categories rose. Moreover, the prevalence of pubertal children, obesity, and waist-to-height ratio above 0.50 progressively increased from lower to upper BP categories. After adjusting for puberty, gender, BMI (z-score), Homeostasis Model Assessment index, and renal function, UA was found to be directly related to systolic and diastolic BP values (P = .03). Using normotensive children for comparison, the risk of showing prehypertension or hypertension increased by at least 50% for each 1 mg/dL UA increase (P , .01), whereas it doubled for children in the top gender-specific UA quartile (P , .03).CONCLUSIONS: Increased UA levels showed an independent predictive power for the presence of higher BP levels among a cohort of children at relatively high cardiovascular risk. Pediatrics 2013;132:e93-e99 AUTHORS:

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“…Overweight and obesity is associated with increased risk of chronic diseases and premature death among minority children (Genovesi et al, 2012;Marcus et al, 2012;Popkin, 2010). The prevalence of overweight and obesity are markedly higher in Mexican American and non-Hispanic black preschool-aged (2-5 years) children relative to their non-Hispanic white counterparts .…”

Section: Introductionmentioning

confidence: 99%

Effects of children's self-regulation of eating on parental feeding practices and child weight

et al. 2014

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Insulin resistance, prehypertension, hypertension and blood pressure values in paediatric age

Abstract: These results strongly support the hypothesis that in children, insulin resistance plays a role on hypertension independently from obesity, fat distribution and puberty across weight classes.

Cited by 35 publications

References 47 publications

Increased Serum Uric Acid Levels Blunt the Antihypertensive Efficacy of Lifestyle Modifications in Children at Cardiovascular Risk

Increased Serum Uric Acid Levels Blunt the Antihypertensive Efficacy of Lifestyle Modifications in Children at Cardiovascular Risk

Serum Uric Acid and Blood Pressure in Children at Cardiovascular Risk

Effects of children's self-regulation of eating on parental feeding practices and child weight

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