Sympathoadrenergic and metabolic factors are involved in ambulatory blood pressure rise in childhood obesity.
We investigated in a young Italian obese population, the relationship between ambulatory BP (ABP) and several pathophysiological factors linking obesity to hypertension. A total of 89 obese children and adolescents underwent a 24-h ambulatory BP monitoring (ABPM) and an oral glucose tolerance test. The circulating levels of insulin, lipids, uric acid, C-reactive protein, interleukin-6, renin and aldosterone and the 24-h urinary levels of epinephrine, norepinephrine and albumin excretion rate were measured. Nine percent of subjects had daytime sustained hypertension (SH), 26% night-time hypertension and 11% a non-dipping pattern. SH subjects compared to those with sustained normotension (SN) were more obese (P<0.05), with a more frequent family history of hypertension (P<0.05), higher urinary catecholamine (P<0.05) and heart rate values (P<0.05) after adjustment for standard deviation score (SDS) of body mass index (BMI) and sex. Subjects with night-time hypertension compared to those with night-time normotension were more obese (P<0.0001), with a higher prevalence of impaired glucose tolerance (P<0.05) and metabolic syndrome (P<0.05) and higher 2-h glucose (P<0.05), uric acid (P<0.05) and triglycerides (P<0.05). In multivariate regression analysis, daytime systolic BP (SBP) remained independently correlated with urinary norepinephrine and SDS-BMI (P<0.05 for both), daytime diastolic BP (DBP) with waist circumference (P<0.05) and night-time SBP and DBP with SDS-BMI (P<0.01 for both). The risk of having systolic and diastolic hypertension increased with the increase in SDS-BMI and waist circumference, respectively. In conclusion, in our cohort of obese children and adolescents, daytime and night-time hypertension were associated with activation of the sympathoadrenal system and worst metabolic conditions, respectively.
Gilardini
L
L
Unit of Metabolic Diseases and Diabetes, Istituto Auxologico Italiano, Milan, Italy.
Parati
G
G
Sartorio
A
A
Mazzilli
G
G
Pontiggia
B
B
Invitti
C
C
D000293:Adolescent; D000419:Albuminuria / Q000652:urine; D000450:Aldosterone / Q000097:blood; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D004837:Epinephrine / Q000652:urine; D005260:Female; D005951:Glucose Tolerance Test; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000235:genetics / Q000503:physiopathology; D007328:Insulin / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D009638:Norepinephrine / Q000652:urine; D009765:Obesity / Q000378:metabolism* / Q000503:physiopathology*; D012083:Renin / Q000097:blood; D012737:Sex Factors; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014527:Uric Acid / Q000097:blood
D007328:Insulin; D015850:Interleukin-6; D008055:Lipids; D014527:Uric Acid; D000450:Aldosterone; D002097:C-Reactive Protein; D012083:Renin; D009638:Norepinephrine; D004837:Epinephrine