Metabolic Abnormalities, Insulin Resistance, and Metabolic Syndrome in Children With Primary Hypertension

Litwin, Mieczysław; Śladowska, Joanna; Antoniewicz, Jolanta; Niemirska, Anna; Wierzbicka, Aldona; Daszkowska, Jadwiga; Wawer, Zbigniew T.; Janas, Roman; Grenda, Ryszard

doi:10.1016/j.amjhyper.2007.03.005

Cited by 72 publications

(74 citation statements)

References 29 publications

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“…The predominant interme diate phenotype of primary hypertension is abnormal body composition with visceral obesity, abnormal muscle-to-adipose tissue proportion and metabolic disturbances typical for metabolic syndrome (Table X) [89,90]. Besides the presence of metabolic disorders directly related to visceral obesity, primary hypertension is characterised by the tendency to higher uric acid levels.…”

Section: Primary Hypertensionmentioning

confidence: 99%

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

Litwin

Niemirska

Obrycki

et al. 2018

Arterial Hypertension

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Presented recommendations are an extended and actualized version of paediatric recommendations of Polish Society of Hypertension published in 2015. Since then, new studies have appeared on this subject, introducing a new classification of hypertension, newly described principles of management in risk groups and methods of assessing hypertensive target organ damage. The presented updated recommendations included changes introduced in the 2016 European Society of Hypertension recommendations and Recommendations of Children's Memorial Health Institute in Warsaw. Recently published guidelines of American Academy of Pediatrics have been discussed. In the presented issue of guidelines, epidemiological information on the occurrence and incidence of hypertension in developmental age was added and classification of blood pressure values was updated. Subchapters on diagnosis and organ damage assessment, principles of diagnosis and treatment of hypertension in children with diabetes, chronic kidney disease and a subsection discussing diagnostic and therapeutic difficulties with setting blood pressure targets were revised. In addition, the principles of early diagnosis of arterial hypertension in post-hospital care in children born before 33 weeks of gestation published in 2018 as recommendations of the Polish Neonatal Society have been also taken into account.

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Section: Primary Hypertensionmentioning

confidence: 99%

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

Litwin

Niemirska

Obrycki

et al. 2018

Arterial Hypertension

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“…[11][12][13]15,16 Low PA, excessive sodium intake, and calcium loss are among the risk factors common not only for osteoporosis but also for PH. 16,17 Because exposure to similar risk factors for both osteoporosis and PH takes place already in childhood, it seems interesting to evaluate the musculoskeletal system at an early stage of PH.The method of choice for the evaluation of both skeletal status and body composition is dual-energy x-ray absorptiometry (DXA). 6 -10,18 -22 DXA offers accurate and precise measurements of total body bone mineral density (TBBMD), total body bone mineral content (TBBMC), lean body mass (LBM; predominantly muscle mass), fat mass (FM), and its fraction of whole body mass.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Bone Mass and Body Composition in Children and Adolescents With Primary Hypertension

et al. 2008

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Abstract-Because primary hypertension (PH) is associated with calcium metabolism, it is hypothesized that PH may be related to osteoporosis risk. The study aimed to evaluate the relationship between body composition and bone strength in hypertensive adolescents. Total body scans using x-ray absorptiometry (DPX-L, GE Healthcare) were performed in 94 PH children aged 6 to 18 years (21 girls and 73 boys). References of healthy control subjects were used for the calculation of Z scores (age and gender matched), SD scores (height and gender matched), and SDs scores (weight and gender matched). Total body bone mineral density, total body bone mineral content (TBBMC), lean body mass (LBM), and fat mass (FM) were investigated. Relative bone strength index was calculated as the TBBMC:LBM ratio. As evidenced by Z scores, PH case subjects had slightly higher total body bone mineral density, TBBMC, and LBM compared with healthy subjects. Reduced LBM/body weight (BW) Z scores of Ϫ1.9Ϯ1.5 and Ϫ1.2Ϯ1.4, increased FM Z scores of ϩ2.5Ϯ2.5 and ϩ1.7Ϯ2.0, and increased FM/BW Z scores of ϩ1.6Ϯ1.3 and ϩ1.1Ϯ1.4 were noted in girls and boys compared with healthy subjects, respectively (PϽ0.001). On the other hand, PH is strictly related to sedentary behavior and nutritional habits with high-sodium and low-calcium intake, and both PH and decreased bone mass are among the main problems of elderly persons. 2,5 Calcium, vitamin D metabolites, proper nutrition, and physical activity (PA) are crucial determinants of peak bone mass. 6 -13 It was shown recently that low serum vitamin D levels correlate with higher blood pressure. 14 Therefore, PH, through its possible associations with calcium and vitamin D metabolism, as well as behavioral factors including nutritional habits and low PA, may alter skeletal status and body composition. Bone mass accrual is highly influenced by mechanical stimulation from skeletal muscles, and the proper muscle-bone interactions during growth are key determinants of skeletal adaptation toward changing loads. [11][12][13]15,16 Low PA, excessive sodium intake, and calcium loss are among the risk factors common not only for osteoporosis but also for PH. 16,17 Because exposure to similar risk factors for both osteoporosis and PH takes place already in childhood, it seems interesting to evaluate the musculoskeletal system at an early stage of PH.The method of choice for the evaluation of both skeletal status and body composition is dual-energy x-ray absorptiometry (DXA). 6 -10,18 -22 DXA offers accurate and precise measurements of total body bone mineral density (TBBMD), total body bone mineral content (TBBMC), lean body mass (LBM; predominantly muscle mass), fat mass (FM), and its fraction of whole body mass. 18 -22 Recently, DXA-derived TBBMC and LBM were implemented as the parameters

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“…47,48 Moreover, juvenile hypertensive patients with left ventricular hypertrophy have a greater body mass index and a greater number of metabolic syndrome components. 49 Juvenile hypertension with obesity is associated with an increased risk of cardiovascular disease. Moreover, obesity in youth tends to be maintained into adulthood, further increasing the risk of adult cardiovascular disease.…”

mentioning

confidence: 99%

Sympathoexcitation by Oxidative Stress in the Brain Mediates Arterial Pressure Elevation in Obesity-Induced Hypertension

et al. 2009

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Background-Obesity is one of the major risk factors for cardiovascular disease and is often associated with increased oxidative stress and sympathoexcitation. We have already suggested that increased oxidative stress in the brain modulates the sympathetic regulation of arterial pressure in salt-sensitive hypertension, which is often associated with obesity. The present study was performed to determine whether oxidative stress could mediate central sympathoexcitation in the initial stage of obesity-induced hypertension. Methods and Results-Four-week-old male Sprague-Dawley rats were fed a high-fat (45% kcal as fat) or low-fat (10% kcal as fat) diet for 6 weeks. Fat loading elicited hypertension and sympathoexcitation, along with visceral obesity. In urethane-anesthetized and artificially ventilated rats, arterial pressure and renal sympathetic nerve activity decreased in a dose-dependent fashion when 53 or 105 mol/kg tempol, a membrane-permeable superoxide dismutase mimetic, was infused into the lateral cerebral ventricle. Central tempol reduced arterial pressure and renal sympathetic nerve activity to a significantly greater extent in high-fat diet-fed hypertensive rats than in low-fat diet-fed normotensive rats. Intracerebroventricular apocynin or diphenyleneiodonium, a reduced NADPH oxidase inhibitor, also elicited markedly greater reductions in arterial pressure and renal sympathetic nerve activity in the high-fat diet-fed rats. In addition, fat loading increased NADPH oxidase activity and NADPH oxidase subunit p22 phox , p47 phox , and gp91 phox mRNA expression in the hypothalamus. Key Words: brain Ⅲ hypertension Ⅲ obesity Ⅲ oxidative stress Ⅲ sympathetic nervous system M etabolic syndrome, a complex of highly debilitating disorders that consist of hypertension, diabetes mellitus, and dyslipidemia, is associated with the development of visceral obesity. 1 All of these features are risk factors for atherosclerosis; therefore, the metabolic syndrome results in a high incidence of cardiovascular events. Although hypertension is one of the major components of the metabolic syndrome, the mechanisms through which obesity contributes to hypertension have not been fully elucidated. Conclusions-In Clinical Perspective p 986Sympathetic activation is often associated with obesity. For example, studies using microneurography have consistently shown increased muscle sympathetic nerve activity in obese subjects. 2 Furthermore, muscle sympathetic nerve activity is closely associated with the level of abdominal visceral fat. 3 As expected, a number of studies indicated that sympathetic activation may be involved in obesity-induced hypertension. 4 In young, nondiabetic Japanese men, body mass index correlated with not only mean blood pressure but also pulse rate and plasma norepinephrine. 5 In an animal study, obese Zucker rats, which display hyperphagia-induced obesity caused by a mutation of the leptin receptor, have elevated sympathetic nerve activity and arterial pressure (AP). 6 Autonomic ganglionic blockade decreased m...

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Metabolic Abnormalities, Insulin Resistance, and Metabolic Syndrome in Children With Primary Hypertension

Cited by 72 publications

References 29 publications

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

Bone Mass and Body Composition in Children and Adolescents With Primary Hypertension

Sympathoexcitation by Oxidative Stress in the Brain Mediates Arterial Pressure Elevation in Obesity-Induced Hypertension

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