title: Association of cardiac NT pro-β-type natriuretic peptide with metabolic and endothelial risk factors in young obese hypertensive patients: a perspective on the hypothalamic pituitary adrenal axis activation.
abstract: BACKGROUND
  In practice, there is increasing recognition of the importance of hypothalamic pituitary adrenal axis in the cardiovascular disease progression. The association of brain natriuretic peptide with obesity and characteristics of the metabolic syndrome in adults and aged patients is well established, but that in pediatrics needs thorough elucidation.
  
  
  OBJECTIVE
  The aim of this study was to assess the association of hypothalamic pituitary adrenal axis mediators (cortisol and aldosterone) with plasma NT-pro β-type natriuretic peptide (NT-proBNP) levels on metabolic, immune-inflammatory and endothelial markers in young obese pediatric patients.
  
  
  METHODS
  This is achieved by recruitment of 60 young (13-17 years) obese pediatric cohorts who are further subclassified according to their stage of hypertension; normotensive, prehypertensive and hypertensive patients.
  
  
  RESULTS
  The study showed significant differences in the metabolic parameters (glucose, insulin and HOMA-index) among the three obese young patient groups. Levels of cortisol and aldosterone, as well as NT-proBNP levels are positively associated with characteristics of the metabolic syndrome; blood pressure, BMI, HOMA index in all three obese groups. However, their association to the lipid profile was insignificant. These increases aligned harmonically with the assessed immune-inflammatory markers; CRP, TNF-α, and IL-23, as well as levels of sICAM, sVCAM and p-selectin, reflecting the involvement of mast cells and inflammatory effects on the vascular endothelium. ROC analysis revealed their beneficial addition as promising biomarkers for a better prognostic profile of hypertension-induced cardiovascular risk.
  
  
  CONCLUSIONS
  Early detection of NT-proBNP, cortisol and aldosterone levels in pre-hypertension stage added to the immune-inflammatory mediators may improve the coronary risk assessment in young Egyptian patients.
authors.affiliation: Department of Biochemistry and Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Misr International University, Km 28, Cairo-Ismailia Road, Cairo, Heliopolis, PO Box 1, Cairo, Egypt.
authors.forename: Mona
authors.initials: M
authors.lastname: Schaalan
authors.affiliation: Chemistry Department, Cairo General Hospital, Cairo, Egypt.
authors.forename: Waleed
authors.initials: W
authors.lastname: Mohamed
authors.affiliation: Pharmacology and Toxicology Department, Misr International University, Cairo, Egypt.
authors.forename: Rania
authors.initials: R
authors.lastname: Rahmo
keywords: Aldosterone; Cortisol; Endothelial markers; Hypertension; Metabolic syndrome; NT-proBNP