Abstract
Objective: In practice, there is increasing recognition of the importance of BNP in the pathophysiology, diagnosis and prognosis of ischemic cardiac dysfunction and heart failure. The association of BNP to obesity and characteristics of the metabolic syndrome in adults and aged patients is well established, but that in pediatrics needs thorough elucidation. Methods: The aim of this study was to assess the association of plasma β-type natriuretic peptide (BNP) levels and metabolic risk factors in 40 young (average age was 13-17 years) obese normo- and hypertensive patients. This is achieved by assessment of serum levels of glucose, insulin, lipid profile as well as the proinflammatory cytokines, TNF- α, interleukin (IL)-6 and IL-23. The assessed metabolic indicators were compared with that of healthy control young subjects with normal BP (120/80 mmHg). Results: Contrasting the reported studies in adult persons, the result of the present study showed that β-type natriuretic peptide (BNP) levels are positively associated with characteristics of the metabolic syndrome; Blood pressure, BMI, HOMA index and the lipid profile in both obese groups. The hypertensive obese group exhibited an increased proinflammatory state, leading to the increased levels of serum levels of TNF-α, IL-6 and IL-23, compared to the obese normotensive group. Conclusion: Early detection of pro-BNP levels in pre-HTN stage is an effective method of prevention of cardiovascular disease. Moreover, proinflammatory mediators, TNF-α, IL-6 should be included in primary screening tests for evaluation of hypertensive patients. However, the prognostic relevance of increased pro-BNP for risk of developing cardiac insufficiency in severely obese patients needs to be further evaluated.
Highlights
The metabolic syndrome (MetS) is a worldwide problem referred to a constellation of Coronary Heart Disease (CHD) risk factors including obesity and abdominal fat distribution, glucose intolerance, hyperlipidemia, hypertension, reflecting the underlying insulin resistance [1]
Brain Natriuretic Peptide (BNP) is synthesized in myocardial cells as a response to increased wall stress in relation to heart failure or acute myocardial ischemia as a prohormone that is cleaved into BNP and N-terminal proBNP (Nt-proBNP)
According to the JNC-7 classification the obese hypertensive patients in group 2 were classified as stage 1 hypertension
Summary
The metabolic syndrome (MetS) is a worldwide problem referred to a constellation of Coronary Heart Disease (CHD) risk factors including obesity and abdominal fat distribution, glucose intolerance, hyperlipidemia, hypertension, reflecting the underlying insulin resistance [1]. Previous studies reported an association between obesity and levels of natriuretic peptides, which are cardiac hormones that played critical roles in ventricular remodeling, salt and water homeostasis, and the regulation of vascular tone [4,5]. Brain Natriuretic Peptide (BNP) is synthesized in myocardial cells as a response to increased wall stress in relation to heart failure or acute myocardial ischemia as a prohormone that is cleaved into BNP and N-terminal proBNP (Nt-proBNP). High BNP as well as high NtproBNP are new promising Cardiovascular (CV) risk markers and have been associated with high Blood Pressure (BP), Left Ventricular (LV) hypertrophy, and albuminuria [6]
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