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Query: UMLS:C0028754 (obesity)
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The children in the population of the district of Prague 4 were screened for the prevalence of hypertension. From the age group 6--11 years (1st--5th forms), a representative sample was selected, comprising 2 152 children; of the age group 12--19 years (6th--9th forms and adolescents), 90% of the population (11 323 individuals) were examined. The arbitrarily set criteria of hypertension 130/80 mmHg in the children aged 6--11 years and 135/80 mmHg in those aged 12--19 years, were found acceptable for identification of potential hypertonics. In the population examined, such or higher pressures were found in 0.5--3.4% of the subjects examined. By thorough clinical and laboratory examinations of children aged 11--15 years with elevated blood pressures the participation of secondary hypertension was determined. In comparison with a control group, these children exhibited statistically significantly more frequent diseases, obesity, and faulty regimen of living, as well as hypertension in their parents.
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PMID:Prevalence of hypertension in children and adolescents. 100 Sep 86

Although essential arterial hypertension is believed to have a strong genetic predisposition, the gene(s) responsible are unknown. The mechanisms underlying the regulation of blood pressure and experimental studies place the renin gene among the main candidate genes that need to be tested in humans. We tested the hypothesis of a linkage between the renin gene and essential hypertension using the affected sib pair method. Siblings (133 subjects, 52.1 +/- 10.9 years) from 57 families were selected for sustained hypertension (160.7 +/- 22.9/99.5 +/- 12.8 mmHg with 80% of patients under antihypertensive treatment), of early onset (40.7 +/- 12.0 years), in the absence of obesity, diabetes mellitus, and secondary hypertension. Eight renin haplotypes were generated from three diallelic renin restriction fragment length polymorphisms (RFLPs) (TaqI, HinfI, HindIII) located throughout the renin gene. The allelic concordance between the sib pairs was analyzed by identity by state relationships for 98 sib pairs (41 for 41 couples, 39 for 13 trios, 18 for 3 quartets). Allelic frequencies in the 57 hypertensive probands were similar to those observed among 102 hypertensive subjects studied previously. Six of eight possible haplotypes were observed, the informativity of the marker corresponded to 70% of heterozygosity. Allelic concordance for all sib pairs according to sibship size was not significantly different from that expected under the hypothesis of no linkage (t = 0.52, P = 0.15) reflecting only a small excess of renin alleles shared by the hypertensive sibs (1.44 +/- 0.6 vs 1.36 +/- 0.6). Likewise the linkage hypothesis was unsupported by weighted estimates to correct for possible bias due to large sibship size. Thus, the sib pair analysis suggests that the renin gene does not have a frequent role in the pathogenesis of essential hypertension; further more powerful linkage studies or other approaches will be needed to detect contributions at the renin locus to the heritability of essential hypertension.
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PMID:Sib pair linkage analysis of renin gene haplotypes in human essential hypertension. 134 86

The incidence of hypertension is increased in obesity, a state associated with an insulin resistance syndrome. By using an euglycemic clamp method, Ferrannini et al. demonstrated the existence of an insulin resistance state in patients with essential hypertension. However, the body mass index of the subjects studied appeared to be slightly excessive. This abnormality has not been observed in patients with secondary hypertension. Insulin resistance is probably localized to peripheral tissues such as muscles and may be associated with other cellular abnormalities. Can insulin resistance, characterized by a raised circulating insulin concentration in the presence of normal blood glucose, be responsible for certain "modifications" associated with essential hypertension? Insulin induces sodium retention and increases the aldosterone-secreting effect of angiotensin II. These effects are likely to promote a rise in blood pressure and an increase in the sensitivity of vessels to endogenous substances. Moreover, insulin is a known growth factor and is involved in lipoprotein metabolism. If insulin resistance plays an important role in the maintenance of complications of essential hypertension, it is important that the treatments used tend to correct this anomaly. Thiazide diuretics and beta-blockers aggravate insulin resistance while angiotensin converting-enzyme inhibitors correct this condition.
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PMID:[Arterial hypertension, hyperinsulinism and insulin resistance]. 143

Hypertension is quite common in the elderly population. Isolated systolic hypertension and diastolic hypertension are associated with cardiovascular complications. Like younger patients, the elderly may have labile hypertension. On the other hand, pseudohypertension, auscultatory gap, and postural hypotension are peculiar to the elderly. Obesity, atherosclerosis, arteriosclerosis, baroreceptor insensitivity, decline in renal function, physical inactivity, and insomnia are factors that can lead to or aggravate hypertension in older patients. Secondary hypertension should be suspected if elevated blood pressure first appears late in life or becomes resistant to previously adequate treatment. Spontaneous hypokalemia can indicate primary aldosteronism. Elevation in the serum creatinine level of a patient taking an angiotensin-converting enzyme (ACE) inhibitor suggests bilateral renovascular hypertension. The goal of antihypertensive therapy is to prevent morbidity, disability, and death from complications and to maintain quality of life. Psychosocial factors may play an important role in controlling hypertension. Nonpharmacologic treatment, such as weight loss, salt restriction, and exercise, should always be tried prior to and in conjunction with medical therapy. Antihypertensive drugs often cause side effects and should be prescribed with caution. Always start with a low dose and gradually increase it if necessary. All drugs that reduce blood pressure in the younger individual also work in the elderly. ACE inhibitors and calcium blockers are particularly useful because of their low incidence of adverse effects.
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PMID:Hypertension in elderly patients. The special concerns in this growing population. 154 24

Non-invasive ambulatory blood pressure monitoring was performed in a consecutive series of 87 subjects with recently detected mild uncomplicated hypertension. Obese subjects, diabetics and those with secondary hypertension were excluded. Ambulatory pressures were recorded on a day of usual activity. Average ambulatory systolic and diastolic pressures were significantly lower than referral pressures determined in clinics or screening sites and initial pressures taken by the monitors. Whereas men (57) and women (30) had similar referral and initial pressures, average ambulatory systolic pressure was significantly higher in men; diastolic pressure was not different. Men also had a significantly higher fraction of ambulatory systolic pressures greater than 140 mmHg compared to women. Fifty-six percent of the men and 80% of the women had average ambulatory systolic pressures less than 140 mmHg and diastolic pressures less than 90 mmHg; the difference between the sexes was significant (chi 2 = 6.99, P less than 0.01). Thus, in mild hypertension, women have lower average systolic pressure than men during ordinary daily activity. These results may account for lower long-term cardiovascular morbidity in hypertensive women compared with men.
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PMID:Differences in ambulatory blood pressure between men and women with mild hypertension. 225 84

The mortality of 3783 non-malignant hypertensive patients attending the Glasgow Blood Pressure Clinic between 1968 and 1983 and followed for an average of 6.5 years was compared with that in three control groups: the general population of Strathclyde a group of 15 422 subjects aged 45-64 years and screened in Renfrew and Paisley between 1972 and 1976, and a group of hypertensives seen in a blood pressure clinic based on general practice in Renfrew. Average blood pressure for men at entry to the Glasgow Clinic was 181/111 mmHg falling to 158/96 mmHg during treatment. Corresponding values for women were 185/109 mmHg and 161/96 mmHg. Seven hundred and fifty clinic patients (451 males) died during follow-up, the commonest causes of death in both sexes being myocardial infarction and stroke. All-cause age-adjusted mortality (deaths per 1000 patient-years) was 41.4 for men and 22.1 for women. At all ages in both sexes and for all levels of initial blood pressure mortality was less in patients whose blood pressure was reduced most. Without a randomized control group it is not certain that lower mortality in those with well controlled blood pressure was due to treatment, although this is the most likely explanation. Cigarette smoking, a history of myocardial infarction, angina or stroke, retinal arterio-venous nipping, raised blood urea, an abnormal electrocardiogram (ECG) and secondary hypertension were associated with increased risk, but heavy alcohol intake, obesity, haematocrit greater than 45%, hypokalaemia and social class were not. Life table analysis showed that, despite some reduction of mortality by treatment, the relative risk to men and women in the clinic remained two- to five-times that of the general population. The benefits of treatment were not such as to restore normal expectation of life even when blood pressure was well controlled. Excess mortality in the clinic could not be explained by difference of smoking habit or social class. This suggests that there is in the hypertensive patients of the Glasgow Clinic an element of irreducible risk, that treatment may be beneficial in some respects but harmful in others, or that patients at particularly high risk are selectively referred to the clinic.
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PMID:Mortality in patients of the Glasgow Blood Pressure Clinic. 371 57

The Na-K cotransport activity was measured in erythrocytes of 123 normotensive and 92 hypertensive patients, using the methodology described by Dagher and Garay. Large overlap of the values obtained in the two populations is observed, in such a way this laboratory test cannot be applied for the discrimination between primary and secondary hypertension. Moreover, the abnormalities described for the Na-K cotransport do not appear specific for primary hypertension. In this study, the influence of hypertensive heredity, but also obesity on this cotransport system could not be demonstrated. However, this transport activity is significantly decreased in patients with chronic renal failure, during treatment with oestro-progestatives or during the oestrogenic phase of the menstrual cycle. These data strongly suggest that the cotransport activity could be modified not only by the hypertensive familial predisposition but also by environmental and hormonal influences.
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PMID:The erythrocyte sodium-potassium cotransport in hypertensive patients: advantages and limitations. 400 62

Essential hypertension in children is difficult to define and is probably very rare. Of 44 children and adolescents diagnosed between 1966 and 1980 to have essential hypertension, we found that only 8 patients continued to be hypertensive, 3 patients turned out to have secondary hypertension and only 5 patients continued to have elevated blood pressures. The incidence of obesity was high in our patients initially diagnosed to have hypertension, but had normalized their weight at the time of reevaluation. The patients with sustained hypertension had initial diastolic blood pressures over 90 mm of mercury at an age of under 12 years and over 100 mm of mercury when older than 12 years of age.
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PMID:[Does essential hypertension exist in childhood?]. 666 52

We have measured the blood pressure to 1500 children aged between 6 and 14 years by sphingomanometric method, using various cuffs according to the recommendations of the A.H.A. Systolic and diastolic pressure was taken and the average value and standard deviations were calculated for each age. On the ground of the values equal or higher than 97 degrees percentil was the presence of 99 subjects afflicted with not secondary hypertension. We noticed that blood pressure increases with the age, is independent of sex, but bears relationship to the presence of obesity (out of 72 obese subjects, 25 were afflicted with hypertension), of menarca (17 hypertensive menstruated out of 27) and of family hypertension (31 hypertensive parents out of 41 examined). Neither relation was found between children's hypertension and socio-economical level nor between hypertension and presence of pathological proteinuria.
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PMID:[Juvenile hypertension. Epidemiological study of 1500 children between 6 and 15 years of age]. 737 49

Hypertension is considered to be "resistant" if a patient's diastolic blood pressure remains above 90 mm Hg despite the use of full doses of three antihypertensive medications. The most likely causes of ineffective blood pressure control include inadequate drug regimens and patient factors such as noncompliance, obesity, cigarette smoking, alcoholism, and "office hypertension." The two most common physiologic causes of resistance are volume overload and secondary hypertension, particularly renovascular disease. When suspicion of renovascular hypertension is high, immediate renal arteriography is indicated. In most patients, however, the less invasive captopril challenge is an adequate screening test. Most hypertensive patients with true resistance can be treated by altering their medication regimen.
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PMID:Resistant hypertension: what to do after trying 'the usual'. 773 25


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