Nonobese and obese hypertensives show similar atherosclerotic changes

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Nonobese and obese hypertensives show similar atherosclerotic changes

9 April 2012

MedWire News: Nonobese adolescents with hypertension have the same cardiovascular deteriorations as their obese hypertensive peers, shows a study in the Journal of Human Hypertension.

However, metabolic alterations and endothelial activation as assessed by plasma biomarkers were more pronounced in obese individuals, report Barbara Glowińska-Olszewska and teamfrom the Medical University of Bialystok in Poland.

Body mass index is independently associated with blood pressure (BP) levels in children; overweight and obesity considerably increase the risk for hypertension, write the authors.

In addition, early markers of atherosclerosis are increased in hypertensive children and adolescents. However, “a vast majority of previously published studies have been confounded by a high proportion of hypertensive subjects, with coincident obesity conferring itself an increased risk for cardiovascular disease,” explain Glowińska-Olszewska and colleagues.

They therefore investigated the vascular status, left ventricular mass, and biomarkers of endothelial activation in 79 newly diagnosed hypertensive adolescents (34 nonobese and 45 obese) who were aged a mean 15.1 years.

All patients had an office systolic and/or diastolic blood pressure greater or equivalent to the 95th percentile for age, gender, and height on three or more occasions.

The researchers determined carotid intima-media thickness (IMT), flow-mediated dilation (FMD), and left-ventricular mass index (LVMi) using ultrasound. They also assessed adhesion molecules and inflammatory interleukins, as well as lipids and insulin resistance (as indicated by Homeostatic Model Assessment [HOMA]).

Obese hypertensive individuals had significantly higher levels of triglycerides, HOMA, interleukin-6, tumor necrosis factor-α, soluble intercellular adhesion molecule-1, and soluble E-selectin than both controls and nonobese hypertensive patients.

FMD was significantly lower in the two hypertensive groups, at 8.5% and 8.1% in nonobese and obese individuals, respectively, than in the control group, at 12.5% (p<0.01).

Conversely, IMT was significantly higher in the two hypertensive groups, at 0.52 mm and 0.54 mm in nonobese and obese individuals, versus 0.42 mm in control patients.

LVMi levels were higher in the two hypertensive groups, with the highest value in the nonobese group, at 37.8 g/m–2.7 versus 28.4 g/m–2.7 in controls (p=0.003).

Thus, the study showed that the obese hypertensive adolescents had altered plasma lipids, insulin resistance, and elevated levels of adhesion molecules and inflammatory markers suggestive of increased cardiovascular risk. However, ultrasonographic evaluation revealed they had similar early atherosclerotic changes to those of nonobese hypertensive individuals of their age, write the authors.

This suggests that young nonobese hypertensive patients have the same cardiovascular risk as their obese hypertensive peers, irrespective of plasma marker levels, they add.

“In conclusion, the potential mechanisms of early atherosclerosis in nonobese hypertensive adolescents need further evaluation in prospective studies because these factors may considerably differ from those found in obese individuals with hypertension.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

J Hum Hypertens 2012; Advance online publication

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