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Hyperinsulinemia and other associated metabolic factors, including hyperglycemia, dyslipidemia, hypertension, and central obesity lead to increased cardiovascular risk and indicate a metabolic syndrome. Levels of fasting insulin were measured in an ethnic Gipsy minority group (n=149) and compared to the majority Slovak population (n=197). The average insulin level was significantly increased in the minority group with a 21% risk value vs 5%. Hyperglycemia was equal in both groups (17% in Gipsy group, 16% in majority group). The incidence of other risk factors for cardiovascular disease and metabolic syndrome is greater in the Gipsy group (47% vs 38%--hypertriacylglycerolemia, 62% vs 46%--HDL-cholesterol level below safety limit, 16% vs 10%--systolic hypertension, 20% vs 11%--diastolic hypertension, 36% vs 22%--obesity). The results of hyperinsulinemia, hypertriacylglycerolemia, hypo-HDL-cholesterolemia, hypertension and obesity indicate, that the Gipsy population is at higher risk for cardiovascular disease. (Tab. 1, Fig. 1, Ref. 12.).
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PMID:Insulin levels in Gipsy minority. 1269 73

To determine whether hypertension and overweight status are associated with increased carotid intimal-medial thickness (cIMT) in children, vascular ultrasonography was performed in newly diagnosed hypertensive patients ( n=53) and normotensive controls ( n=33). Hypertensive subjects were identified either by referral or by systematic school-based hypertension screening. Hypertension was defined as blood pressure above the 95th percentile based on current Task Force criteria, and overweight was defined as body mass index (BMI) >25 kg/m(2). cIMT was assessed by high-resolution vascular ultrasonography of the distal common carotid artery. Hypertensive subjects had a higher cIMT than normotensive subjects (0.62 vs. 0.53 mm, P<0.00001). This difference remained significant after controlling for the effects of gender, race, age, height, weight, and BMI. Similarly, overweight subjects had a higher cIMT than normal-weight subjects (0.63 vs. 0.54 mm, P<0.0001). Subjects with both systolic and diastolic hypertension had higher cIMT than those with isolated systolic hypertension (0.67 vs. 0.60, P<0.05). cIMT showed significant positive pairwise correlation with age, height, weight, BMI, and systolic blood pressure. Among all clinical variables analyzed, cIMT was most strongly correlated with BMI ( r=0.53, P<0.001). These results provide further evidence that vasculopathy occurs in association with known cardiovascular risk factors such as hypertension and obesity during childhood.
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PMID:Carotid ultrasonography for detection of vascular abnormalities in hypertensive children. 1288 75

Angiotensin-II receptor blockers (ARBs) have been shown to provide stroke, cardiac and renal protection in high-risk hypertensive patients. Telmisartan is a powerful and selective ARB that provides sustained blood pressure reduction for a full 24 h after a single dose and continues to protect against circadian blood pressure surges in the critical early morning hours. The objective of the Programme of Research tO show Telmisartan End-organ proteCTION (PROTECTION) is to measure the end-organ protective effects of telmisartan in patients at high risk of renal, cardiac and vascular damage. An extensive series of clinical trials is being conducted to compare telmisartan with valsartan, losartan, amlodipine and ramipril in patients at increased risk of end-organ damage. Nine clinical studies will examine the effects of telmisartan in about 5000 hypertensive patients with isolated systolic hypertension, type 2 diabetes, obesity, left ventricular hypertrophy or renal disease. All of the studies will be conducted using state-of-the-art technology, including such techniques as ambulatory blood pressure monitoring and magnetic resonance imaging. This programme will also investigate the effects of an ARB on key surrogate markers of organ tissue damage. This series of trials will characterize the end-organ protective effects of telmisartan in hypertensive patient populations at high risk of clinical events.
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PMID:The telmisartan programme of research tO show Telmisartan End-organ proteCTION (PROTECTION) programme. 1451 50

A follow-up study of first-degree relatives of type 2 diabetic patients presented the opportunity to study the association of components of the metabolic syndrome with oral glucose tolerance in these subjects. In 1992, 25 years after the first analysis of the cohort, we performed 75-g oral glucose tolerance tests and measured anthropometric data (body mass index, waist-hip ratio), insulin and C-peptide concentrations, and parameters of lipoprotein metabolism (free fatty acids, triglycerides, cholesterol, HDL cholesterol). Of 135 participants, 71 had normal glucose tolerance (GT), 22 had impaired GT, and 42 had diabetic GT (WHO 1985 criteria). Impaired glucose tolerance and diabetes were significantly (Kruskal-Wallis test) associated with advanced age (p=0.001), higher body mass index (p=0.005) and waist-hip ratio (p=0.027), systolic hypertension (p=0.031), elevated basal insulin concentrations (p<0.001), higher free fatty acids (p<0.001) and triglycerides (p=0.017), and lower HDL cholesterol (p=0.003); no associations were found with total and LDL cholesterol levels (Friedewald's formula, p=0.25). Abnormalities (obesity, hypertriglyceridemia, low HDL cholesterol, hypertension, pathological oral glucose tolerance) were associated with significant deterioriations in all other components of the metabolic syndrome, if their number exceeded three. Disturbances of oral glucose tolerance are present in a high percentage of first-degree relatives after 25 years of follow-up (51% of those tested). Impaired or diabetic glucose tolerance in such a cohort was associated with overweight, hypertension and disturbances of lipoprotein metabolism characteristic of the metabolic syndrome. Hypercholesterolemia (LDL-cholesterol) is not a component of the metabolic syndrome in a German population with a high hereditary burden regarding type 2 diabetes. A metabolic syndrome should certainly be diagnosed if three components are present, although even in the presence of only two components, an elevated risk is evident.
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PMID:A 25-year follow-up study of glucose tolerance in first-degree relatives of type 2 diabetic patients: association of impaired or diabetic glucose tolerance with other components of the metabolic syndrome. 1474 Feb 75

Obesity is associated with high insulin and leptin levels. Studies also suggest that high levels of insulin and leptin increase sympathetic nervous system (SNS) activity and engender increased chronotropy, vasoconstriction and antinatriuresis that may contribute to the pathogenesis of obesity related hypertension. Sympathetic modulation of cardiovascular responses requires good baroreceptor sensitivity and optimal vascular compliance. The vascular changes associated with isolated systolic hypertension (ISH) have been shown to modify baroreceptor sensitivity and vascular compliance and may mitigate sympathetic modulation of cardiovascular responses and attenuate the hypertensive effect of obesity. The purpose of this study is to examine the differences in the relationship between body mass index, pulse rate (PR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) among participants with normal blood pressure and ISH using data from the third National Health and Nutrition Examination Survey. Data from 13,761 non-institutionalized adults 18 years and older not receiving antihypertensive therapy were analyzed. Results showed that PR, SBP and DBP increase with increasing BMI. The rise in PR, SBP and DBP with BMI is higher among participants with normal blood pressure than among those with ISH. We concluded that increasing level of obesity is associated with a rise in pulse rate and blood pressure but the effect of obesity on blood pressure and pulse rate might be weaker among participants with ISH.
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PMID:The relationship between body mass index, blood pressure and pulse rate among normotensive and hypertensive participants in the third National Health and Nutrition Examination Survey (NHANES). 1498 2

The pathogenic role of angiotensin II (ANG II), dietary sodium chloride, sympathetic activation, obesity and aldosterone in the development of structural vascular changes (SVCs) in hypertension is considered from three perspectives (criteria): their utility in predicting hypertension and its complications (predictability); the effect of their inhibition or removal on the reversal of SVCs (reversibility); and their ability to induce SVCs in experimental animals (reproducibility). Only ANG II meets all three criteria. Importantly, ANG II increases preglomerular vascular resistance by inducing structural changes in renal cortical resistance arteries and arterioles. High salt intake, by dilating and thereby stiffening some arteries, may play a role in the development of systolic hypertension with aging, but does not produce structural changes in renal cortical resistance vessels. While high circulating levels of norepinephrine are associated with SVCs, the experimental evidence for the role of sympathetic nerve stimulation in the development of SVCs is inconclusive. Obesity is associated with hypertension, but is not known to be associated with SVCs. Salt-loading is required for aldosterone to produce SVCs, but vascular pathology in this experimental model differs from that in benign essential hypertension. The findings of this review indicate that SVCs in extra-renal sites by themselves do not lead to hypertension; structural changes in renal cortical arteries and arterioles that increase preglomerular vascular resistance are needed. Progressive trophic stimulation of preglomerular resistance vessels by itself may lead to hypertension. ANG II is prime candidate for such stimulus.
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PMID:Pathogenesis of structural vascular changes in hypertension. 1516 59

Obesity is associated with the development of hypertension but it is still not clear why hypertension is not observed in all obese patients. Obesity is a risk factor for the development of obstructive sleep apnea syndrome (OSAS) in children. OSAS has been linked to the development of hypertension in adults and children. The purpose of this study was to test the hypothesis that OSAS is one of the reasons that some obese children are hypertensive and some are not. The overnight polysomnography records of 90 patients (aged 4.2-18.8 years) were reviewed. BMI(score) [body mass index (BMI)/95th percentile BMI for age, sex, and race] was used to express the degree of obesity. The severity of systolic hypertension and diastolic hypertension were expressed as SBP(score) (systolic BP/the 95th percentile systolic BP for age, sex, and height) and DBP(score) (diastolic BP/the 95th percentile diastolic BP for age, sex, and height), respectively. OSAS was defined as more than one episodes of apnea per hour (AI) or an O(2) saturation associated with obstructive apnea of less than 90%. There were 56 obese patients; 42 were hypertensive and 40 patients were diagnosed with OSAS. The incidence of hypertension (68% vs. 30%) and obesity (75% vs. 52%) was higher in OSAS patients than those without OSAS. Compared with the non-obese patients, obese patients had a higher incidence of hypertension or OSAS, a higher BMI(score), SBP(score), DBP(score), AI, hypopnea index (HI), and apnea-hypopnea index (AHI). In obese patients, both SBP(score) and DBP(score) correlated positively with BMI(score), arousal index, and HI. DBP(score) also correlated positively with AHI. Multiple regression analysis showed that HI and BMI(score) were significant independent predictors of SBP(score) or DBP(score). Obese and hypertensive patients had a higher HI, AHI, and incidence of OSAS (64% vs. 29%) than the obese and normotensive patients. In conclusion, HI had a significant correlation with the degree of hypertension in obese patients, which could not be attributed to the degree of obesity. These findings are consistent with the hypothesis that OSAS is one of the reasons why some obese children are hypertensive and some are not.
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PMID:Hypopnea in pediatric patients with obesity hypertension. 1517 71

The aim of the study was to evaluate the level of habitual physical activity in Croatian physical education (PE) teachers, as well as the existence of some other risk factors for the development of cardiovascular diseases (CVD). The sample consisted of 191 PE teachers aged 24 to 59 years (122 men, mean age 42.6+/-8.76 and 69 women, mean age 40.3+/-8.84;p=0.09). In order to assess the level of habitual physical activity, the teachers were asked to fill in Baecke's questionnaire. The questionnaire comprises 16 items testing physical loads at work, during sport activity and during leisure time. The questionnaire also contains 8 items, each of them representing a certain cardiovascular risk factor. In comparison to average adult employed population, PE teachers have a significantly higher level of sport and leisure time activity, which could have a favorable impact on the incidence of particular risk factors, such as overweight/obesity, systolic hypertension and blood cholesterol level. This is more obvious in females PE teachers who pay more attention to the principles of healthy life style: optimal body weight regulation, low fat diet and higher amount of leisure time physical activity (significantly higher than in male teachers). Female PE teachers who have maintained their active life style decrease the risk of CVD, particularly after the age of 55. Although it is necessary to keep in mind all the limitations of a questionnaire study, this preliminary report leads to the conclusion that male PE teachers, although physically active at job, have still kept sedentary habits, often have maintained heavy smoking habits, are slightly overweight, thus minimizing the positive effects of their demanding workplace. Consequently, average male PE teachers' risk for CVD development corresponds to the risk of general male population.
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PMID:Gender differences in cardiovascular diseases risk for physical education teachers. 1557 Oct 98

Hypertension in older persons is characterized by increased systolic blood pressure, and isolated systolic hypertension (ISH) is the most common type of hypertension in this population. It is thought that ISH results from age-associated vascular stiffening and reduced compliance that can be revealed and quantified by analysis of arterial pressure waveforms. Evaluation of pulse wave velocity and other related measures has shown that arterial stiffness increases with advancing age and other cardiovascular (CV) risk factors including hypertension, the metabolic syndrome, diabetes, obesity, hypercholesterolemia, and elevated C-reactive protein. Many of these relationships have been demonstrated in patients without clinical CV disease and are independent of patient age. Arterial stiffness is significantly and independently associated with both target organ damage and increased risk for CV morbidity and mortality. The mechanisms underlying age- and disease-related arterial stiffening are not fully understood. However, assessment of changes in gene expression associated with increased arterial stiffness and gene polymorphisms that increase the risk for vascular stiffening suggests that components of the renin-angiotensin system, matrix metalloproteinases, intracellular signaling, and extracellular matrix components may all be involved in this process. Interventions aimed at these targets may reduce vascular stiffness, lower systolic blood pressure, decrease the prevalence of ISH, and improve outcomes for patients (particularly older patients) with hypertension or other CV conditions.
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PMID:Vascular stiffening and arterial compliance. Implications for systolic blood pressure. 1560 34

Primary hypertension is well known to occur in children, but the characteristics of such children are changing due to the influence of the obesity epidemic. In view of this, we conducted a cross-sectional study of 70 children [age 13.3+/-4 years (mean +/- SD)] with primary hypertension referred to a specialized pediatric hypertension clinic. Secondary hypertension had been excluded after a standardized diagnostic evaluation. Isolated systolic hypertension was present in 62.9% of subjects. Family history of hypertension was present in 86.2%, and 52.9% were obese (BMI > or =95th percentile). BMI was weakly correlated with systolic BP (r =0.28,P =0.10) and was significantly correlated with total cholesterol (r =0.36,P =0.005) and triglycerides (r =0.42,P =0.01). Mean plasma renin activity (PRA) was 3.1+/-2.7 ng/ml/h. PRA was correlated with diastolic but not systolic BP. Patients with high PRA had higher diastolic BP and lower BMI compared to those with low PRA. Left ventricular hypertrophy was present in 24%. Mean 24-h systolic BP load by ambulatory BP monitoring was 52+/-24%; mean 24-h diastolic BP load was 18+/-16%; BP loads were greater in patients with high PRA. These data suggest that primary hypertension in children is characterized by systolic BP elevation, positive family history and obesity. Hyperlipidemia accompanies primary hypertension in obese children, and left ventricular hypertrophy is common. Patients with high PRA have more severe BP elevation. Future studies should focus on further defining the pathophysiology of primary hypertension in children, including the roles of renin and insulin resistance, so that improved methods of prevention and treatment can be developed.
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PMID:Characteristics of children with primary hypertension seen at a referral center. 1586 53


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