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Hypertension is an important global health issue and is currently increasing at a rapid pace in most industrializing nations. Although a number of risk factors have been linked with the development of hypertension, including obesity, high dietary sodium, and chronic psychosocial stress, these factors cannot fully explain the variation in blood pressure and hypertension rates that occurs within and between populations. The present study uses data collected on adults from three indigenous Siberian populations (Evenki, Buryat, and Yakut [Sakha]) to test the hypothesis of Luke et al. (Hypertension 43 (2004) 555-560) that basal metabolic rate (BMR) and blood pressure are positively associated independent of body size. When adjusted for body size and composition, as well as potentially confounding variables such as age, smoking status, ethnicity, and degree of urbanization, BMR was positively correlated with systolic blood pressure (SBP; P < 0.01) and pulse pressure (PP; P < 0.01); BMR showed a trend with diastolic blood pressure (DBP; P = 0.08). Thus, higher BMR is associated with higher SBP and PP; this is opposite the well-documented inverse relationship between physical activity and blood pressure. If the influence of BMR on blood pressure is confirmed, the systematically elevated BMRs of indigenous Siberians may help explain the relatively high blood pressures and hypertension rates documented among native Siberians in the post-Soviet period. These findings underscore the importance of considering the influence of biological adaptation to regional environmental conditions in structuring health changes associated with economic development and lifestyle change.
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PMID:The influence of basal metabolic rate on blood pressure among indigenous Siberians. 1847 Aug 97

The purpose of this study was to investigate the combined impact of obesity and physical activity (PA) on the health of older adults. Pedometer-determined steps/d, body-mass index (BMI), resting blood pressure, and fasting glucose (FG) were assessed in 137 older adults (69.0 +/- 8.9 yr). The active group (>4,227 steps/d) had lower systolic blood pressure (SBP; p = .001), diastolic blood pressure (DBP; p = .028), and FG (p < .001) than the inactive group (< or = 4,227 steps/d). The normal-BMI group (18.5-24.9 kg/m2) had lower SBP (p < .001) and DBP (p = .01) than the obese group (> or =30 kg/m2). There were no differences in SBP (p = .963) or DBP (p = 1.0) between active obese and inactive normal-BMI groups. The active obese group, however, had a more favorable FG than the inactive normal-BMI group (chi 2 = 18.9, df = 3, p = .001). Efforts to increase PA of older adults should receive the same priority as reducing obesity to improve BP and FG levels.
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PMID:The impact of body-mass index and steps per day on blood pressure and fasting glucose in older adults. 1848 41

Insulin resistance (IR) and obesity may be associated with impaired response to physical exercise. We aimed at assessing physical capacity in obese children with biopsy proven non-alcoholic fatty liver disease (NAFLD) as compared to normal weight and obese children without fatty liver disease. All male subjects, 20 NAFLD and 31 control individuals (20 obese, without NAFLD and 11 normal weight children) took part in the study. We evaluated changes in cardiovascular parameters during a bicycle-ergometer exercise test (James' test). Duration, power of exercise, heart rate (HR), blood pressure (BP), pulse pressure, cardiac output ((I)CO) and total peripheral vascular resistance indexed for height ((I)TPVR) were recorded at rest ((r)) and peak ((p)) exercise. The homeostatic model assessment was used to determine insulin resistance (HOMA-IR) and beta-cell action (HOMA-beta cell). In NAFLD and obese subjects, fasting leptin, insulin secretion, insulinogenic index (IGI), muscle insulin sensitivity (MISI) and hepatic insulin resistance index (HIRI) were assayed. Children with NAFLD were the most insulin-resistant (P = 0.001), and showed higher HIRI than obese controls (P = 0.05). At rest, they had the lowest values of SBP(r) (P = 0.001 vs. controls and P < or = 0.05 vs. obese controls); during the test, the highest values of (I)CO(p) (P = 0.005), Delta(I)CO (P = 0.003) and DeltaTRVP(p) (P < or = 0.0001). NAFLD and obese controls both had impaired DeltaHR(p) (P < or = 0.0001). However, obese controls were not able to reduce peripheral resistance during the test. HOMA-IR explained 28% of variance in Delta(I)CO of the whole sample, (P < or = 0.0001). In obese children with or without NAFLD, increased IR and body weight may induce cardiovascular compensatory changes in response to physical exercise with fairly different pathogenetic mechanisms, which are likely to be dependent on the different degree of IR.
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PMID:Insulin resistance and exercise capacity in male children and adolescents with non-alcholic fatty liver disease. 1883 55

This study aimed at assessing the anthropometry, dietary intake and micronutrient status of hypertensive patients attending specialist hospitals in Ondo State, Nigeria. A descriptive case control study was conducted among subjects attending two specialist hospitals located in Akure and Ondo towns. A total of 452 subjects (44.9% males and 55.1% females), was purposely selected from the study centres. A structured questionnaire was designed to collect information on demographic characteristics, socio-economic parameters, nutrition knowledge and dietary intakes of the subjects. The quantities of subjects' dietary intakes were measured using household measurements. Weight, height, systolic (SBP) and diastolic (DBP) blood pressures were measured using electronic bathroom scale, standiometer and sphygmomanometer, respectively. The subject's urine was collected; and vitamin C, sodium, potassium, calcium, zinc and magnesium were determined using standard procedures. The results showed the following means: age 52.4 +/- 2.38 years, weight 66.4 +/- 1.63kg, height 1.64 +/- 0.01m, body mass index (BMI) 24.13 +/- 0.69kg/m2, SBP 124.86 +/- 2.3mmHg and DBP 76.22 +/- 1.86 mmHg. Blood pressure (BP) of the subjects showed that 46.9% had optimal BP, 14.2% normal BP, 11.5% high normal BP, 12.8% mild hypertension, 9.7% moderate hypertension and 4.9% severe hypertension. For BMI, 8.8% were underweight, 47.1% normal, 30.3% overweight, 6.0% obesity class I, 6.0% obesity class II and 1.8% obesity class III. The proportion of hypertensive subjects that were obese was significantly (P = 0.0001) higher than control subjects. Three-fifth of the control subjects had good nutrition knowledge compared to one-fifth of hypertensive subjects. The estimated mean energy intake was 8.46 MJ, protein 93.1g, carbohydrate 314.5g, fat 42.9g, fibres 5.6g and appreciable amount of vitamin C, calcium, zinc, magnesium, sodium and potassium. The subjects' urinary vitamin C concentration was 32.49 +/- 2.53mg; calcium 0.41 +/- 0.06mg, zinc 0.04 +/- 0.01mg; magnesium 4.57 +/- 0.37mg, sodium 8.33 +/- 0.37mg) and potassium 7.45 +/- 0.21mg. Statistically, there were significant differences (P < 0.05) between urinary vitamin C, sodium and potassium concentration (except zinc) of hypertensive patients and the control subjects. Weak correlations were observed between the subjects' systolic (P < 0.05) and diastolic (P < 0.01) BP and age, BMI and magnesium; with inverse correlations between vitamin C, sodium and potassium. The study concluded that hypertension was significantly influenced by BMI of the subjects, which may be an indication of high intake of calories. Therefore, calorie intake should be controlled among the hypertensives.
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PMID:Nutritional knowledge, nutrients intake and nutritional status of hypertensive patients in Ondo State, Nigeria. 1884 81

To examine the influence of sexual maturation (SM) on blood pressure (BP) and body fatness during puberty among African-American children. Longitudinal data were collected from 283 African-American children aged 9-15 years over a 1.5-year period. Measured anthropometric measures included height, weight, skinfold thickness, waist circumference (WC), and systolic and diastolic BP (SBP/DBP) at baseline, 1-year, and 1.5-year follow-up were used. SM was assessed using self-reported Tanner stages (range 1-5) at baseline. Spearman correlation and regression analyses were conducted to test associations between study variables. Early maturing girls had higher BP and body mass index (BMI = weight (kg)/height (m)(2)) at follow-up than nonearly maturing girls (SBP: 117.4 vs. 111.7; DBP: 66.3 vs. 60.7; BMI: 27.7 vs. 23.5; all P < 0.05, respectively). Baseline Tanner stage was positively associated with follow-up SBP (r = 0.28), DBP (r = 0.37), BMI (r = 0.45), skinfold thickness (r = 0.37), and WC (r = 0.40) in girls, but not in boys. The influence of SM on BP independent of body size was tested via several different multiple linear regression models by adding measures of body size and their changes (height and BMI) between baseline and follow-up. Early maturing girls had higher SBP and DBP (beta = 4.30, P < 0.05; beta = 3.28, P < 0.05; respectively) and BMI (beta = 1.69, P < 0.05) at 1.5-year follow-up than their counterparts. In boys, a marginally significant reverse association (beta = -1.05 to -1.19) between SM stages and DBP was detected. SM affects BP and body fatness in girls, and should be considered in assessment of BP and obesity in adolescents.
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PMID:The influence of sexual maturation on blood pressure and body fatness in African-American adolescent girls and boys. 1894 13

Hypertension and obesity are likely the most common disease in Japan. It has been reported that subjects with prehypertension (systolic blood pressure [SBP] 120-139 mmHg and/or diastolic blood pressure [DBP] 80-89 mmHg) have also an increased risk of cardiovascular disease; however, only limited data are available on the prevalence of prehypertension and its association with body weight. We performed a cross-sectional study to examine whether the status of body weight was associated with prehypertension. Study participants aged 19 to 90 years [1,207 men aged 60 +/- 15 (mean +/- standard deviation) years and 1,634 women aged 63 +/- 12 years] were randomly recruited for a survey at the community-based annual medical check-up. The prevalence of prehypertension was 27.3% in men and 23.9% in women. The levels of SBP and DBP increased, as body mass index (BMI) increased in both genders. In a multivariate-adjusted model, increasing BMI categories were positively associated with prehypertension. Especially in men, compared to participants with BMI of < 21.0 kg/m(2) (referent), the multivariate-odds ratio (95% CI) of prehypertension was 1.90 (1.17-3.09) in the 21.0-23.4 kg/m(2) group, 2.38 (1.31-4.34) in the 23.5-24.9 kg/m(2) group, and 3.79 (2.03-7.09) in the > or = 25.0 kg/m(2) group. In conclusion, even subjects with mildly increased BMI (21.0-24.9 kg/m(2)) had an increased risk of prehypertension in community-dwelling persons. It is time to pay more attention to excess bodyweight in preventing high blood pressure.
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PMID:High prevalence of prehypertension is associated with the increased body mass index in community-dwelling Japanese. 1906 Apr 50

The increasing prevalence of metabolic syndrome (MS) poses a serious public-health problem worldwide. Effective prevention and intervention require improved understanding of the factors that contribute to MS. We analyzed data on a large twin cohort to estimate genetic and environmental contributions to MS and to major MS components and their intercorrelations: waist circumference (WC), systolic (SBP) and diastolic blood pressure (DBP), fasting plasma glucose (FPG), triglycerides (TGs), and high-density lipoprotein-cholesterol (HDL-C). We applied structural equation modeling to determine genetic and environmental structure of MS and its major components, using 1,617 adult female twin pairs recruited from rural China. The heritability estimate for MS was 0.42 (95% confidence interval (CI): 0.00-0.83) in this sample with low MS prevalence (4.4%). For MS components, heritability estimates were statistically significant and ranged from 0.13 to 0.64 highest for WC, followed by TG, SBP, DBP, HDL-C, and FPG. HDL-C was mainly influenced by common environmental factors (0.62, 95% CI: 0.58-0.62), whereas the other five MS components were largely influenced by unique environmental factors (0.32-0.44). Bivariate Cholesky decomposition analysis indicated that the clinical clustering of MS components may be explained by shared genetic and/or environmental factors. Our study underscores the importance of examining MS components as intercorrelated traits, and to carefully consider environmental and genetic factors in studying MS etiology.
Obesity (Silver Spring) 2009 Aug
PMID:Genetic and environmental contributions to phenotypic components of metabolic syndrome: a population-based twin study. 1940 9

Obesity is associated with elevated blood pressure (BP), insulin resistance, and altered plasma adiponectin levels; the relationship between the biochemical features of obesity and 24-h ambulatory blood pressure (24-h ABP) parameters in adolescents remains unknown. Anthropometric measurements and 24-h ABP monitoring were obtained on 41 obese adolescents with and without type 2 diabetes mellitus (T2DM). Serum adiponectin, high sensitivity C-reactive protein (hs-CRP), lipid profile, insulin, fasting glucose, liver enzymes, Hb A1c (HbA1c), and two random urine samples were obtained for creatinine and microalbumin measurements. The determinants of 24-h systolic (SBP) and diastolic (DBP) BP were examined using multivariate linear regression models with BP parameters as outcome variables. Forty-one obese adolescents were studied. Adiponectin levels were reduced and hs-CRP levels were elevated, and were inversely and significantly correlated (rho = -0.3, p = 0.05). ABP showed blunted nocturnal SBP dipping. Twenty-four hour SBP and DBP indexes were significantly (p < 0.05) and inversely correlated with adiponectin (rho = -0.4 and -0.42), respectively. In multivariate models, lower adiponectin level was independently associated with 24-h SBP and DBP. Adiponectin inversely correlate with ABP parameters in obese adolescents. Larger studies are needed to examine the relationship between adiponectin and mechanisms of BP regulation.
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PMID:Relationship between adiponectin and ambulatory blood pressure in obese adolescents. 1943 Mar 83

Increased aldosterone has been associated with obesity and the metabolic syndrome in non-HIV-infected individuals, but aldosterone has not been investigated among HIV-infected patients with increased visceral adipose tissue (VAT). Twenty-four-hour urine aldosterone was assessed among age and BMI-matched HIV-infected women with increased VAT, HIV-infected women without increased VAT and healthy controls. Twenty-four hour urine aldosterone was higher in HIV-infected women with increased VAT and was associated with SBP, VAT and hemoglobin A1c. Increased aldosterone may contribute to the detrimental effects of excess visceral adiposity on blood pressure and glucose homeostasis among HIV patients.
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PMID:Increased aldosterone among HIV-infected women with visceral fat accumulation. 1977 Jun 20

Previous meta-analyses investigating blood pressure effects of anti-obesity drugs have included studies using non-licensed doses, but not data from head-to-head studies. Furthermore, although diabetes is an important comorbidity in obesity, variation in blood pressure effects across diabetes status has not been investigated. The objective of this study was to estimate the effects on systolic (SBP) and diastolic blood pressure (DBP) of orlistat and sibutramine. Medline, EMBASE, the Cochrane controlled trials register and reference lists of identified articles from 1990 to February 2009 were searched. All placebo-controlled randomized controlled trials of 12-month duration or randomized head-to-head studies of any duration on adults using standard doses were included. Studies/study arms were excluded if they only evaluated weight maintenance after weight loss. Randomized controlled trials were identified, subjected to inclusion and exclusion criteria, and reviewed. Random effects models were used for assessment of weighted mean differences. Eighteen placebo-controlled (12 orlistat, 5540 patients; 6 sibutramine, 1495 patients) and four head-to-head trials (348 patients) met the inclusion criteria. Three orlistat and three sibutramine studies examined overweight subjects with type 2 diabetes (T2DM), as did two head-to-head trials. Mean baseline SBP ranged from 119 to 153 mmHg, and mean DBP from 69 to 98 mmHg. Overall, the placebo-controlled SBP change was -1.9 (95% CI; -2.7, -1.1) mmHg for orlistat, and 0.5 (-1.1, 2.1) mmHg for sibutramine. The corresponding values for DBP were -1.5 (-2.2, -0.8) and 1.7 (0.7, 2.6). Compared with patients without diabetes, diabetic patients treated with orlistat experienced smaller and non-significant reductions of SBP (-0.9; -2.6, 0.7 vs. -2.2; -3.0, -1.3) and DBP (-1.0; -2.4, 0.3 vs. -1.6; -2.4, -0.8). For sibutramine, higher on-treatment elevations in SBP (1.6; -1.3, 4.5 vs. 0.1; -1.8, 2.0) and DBP (2.4; 0.6, 4.1 vs. 1.4; 0.3, 2.5) were seen in patients with vs. without diabetes. In head-to-head trials, the overall differences between sibutramine and orlistat were small and non-significant for both SBP (1.0; -2.3, 4.3) and DBP (-0.2; -2.9, 2.5). In conclusion, in the studies using approved sibutramine doses, the drug caused significant elevations in DBP, while the overall SBP effect was near null. Moreover, absence of a blood pressure-lowering effect of orlistat ad a higher DBP elevation by sibutramine were observed for persons with diabetes. Head-to-head studies indicated that an indirect comparison of placebo-adjusted blood pressure effects may overestimate the adverse effects associated with sibutramine, but these studies were small, of shorter duration and of lower quality.
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PMID:Long-term changes in blood pressure following orlistat and sibutramine treatment: a meta-analysis. 2002 93


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