Hypertension In Obese Children Research Articles

Diagnosis and Management of Hypertension in Obese Children

The prevalence of hypertension in overweight and obese children is 14% and 33%, respectively. Additional information such as age, gender, and height needed to define hypertension in children. In addition, blood pressure measurement in obese children faces many challenges. Therefore, the diagnosis of hypertension in obese children needs to be carefully considered. Body weight reduction through diet management and physical activity remain the main management strategy for hypertension in obese children. Persistent hypertension after 6-12 months despite a healthy lifestyle needs additional medication.

Potentials of Hyperuricemia and Insulin Levels in Predicting Hypertension in Obese Children: A Cross-Sectional Study

Background: Recent studies in humans show that increased uric acid predicts hyperinsulinemia and obesity. Objectives: Our study aimed to investigate whether hyperuricemia and insulin levels predict hypertension in obese children. Methods: This analytical cross-sectional study was conducted on the records of 161 obese children aged 5 to 15 years old based on the defined inclusion criteria. Children's blood pressure, height, weight, FBS (fasting blood sugar), HDL (high-density lipoprotein), LDL (low-density lipoprotein), TG (triglyceride), HbA1c (hemoglobin A1c), urine albumin, creatinine, insulin levels, and uric acid were measured. Data were analyzed by SPSS software. The significance level was considered P < 0.05. Results: According to the data obtained from this study, the mean of SBP (systolic blood pressure) and DBP (diastolic blood pressure) in obese children with hyperuricemia was higher than in obese children without hyperuricemia. The average insulin in obese children and hypertension was higher than in obese children without hypertension, especially in males and the age group of 5 - 10 years. The levels of cholesterol and LDL in hypertensive males were higher than in those with hyperuricemia. HDL was higher in children without hyperuricemia than in children with hyperuricemia. The strongest predictors of uric acid were age (P < 0.001, B = 0.183), HbA1c (P = 0.014, B = 0.255), and cholesterol (P = 0.03, B = -0.007), respectively. Conclusions: Based on this study, there is a relationship between uric acid levels and parameters such as obesity and blood pressure, and the findings showed that increased uric acid predicts hyperinsulinemia and obesity. Therefore, this study indicates that physicians and healthcare workers should consider the level and state of uric acid.

High molecular weight adiponectin as a biomarker of hypertension in children and adolescents with obesity.

Lower HMW (high molecular weight) adiponectin levels are associated with obesity, insulin resistance, and metabolic syndrome in children and adolescents. However, data on HMW levels in pediatric population with hypertension are lacking. This study aimed to examine the association and predictive capacity of HMW levels, HMW/HOMA-IR, and HMW/APN ratio with hypertension in obese children and adolescents. The 299 pediatric subjects were grouped in obese hypertensive (OH), obese normotensive (ON), and normal weight normotensive (NN). Plasma concentrations of HMW were investigated by ELISA. ANOVA was used to compare study groups, and a binary logistic regression analysis was used to verify if HMW, HMW/HOMA-IR, HMW/APN, APN, APN/HOMA-IR, and HOMA-IR are associated to hypertension regardless obesity in children and adolescents. To compare the strength and performance of each biomarker to classify individuals with and without hypertension, the receiver-operating characteristic (ROC) curve, area under the curve (AUC), and Youden index (J) were evaluated. Both HMW plasma levels and the HMW/HOMA-IR ratio were significantly lower in the OH group when compared to the ON group (HMW: 2.00 ± 1.33µg/mL vs 2.48 ± 1.48µg/mL; HMW/HOMA-IR ratio: 0.87 ± 0.95 vs 1.27 ± 1.2; P < 0.05) and NN weight groups (HMW: 2.00 ± 1.33µg/mL vs 4.02 ± 1.99µg/mL; HMW/HOMA-IR ratio: 0.87 ± 0.95 vs 2.62 ± 1.86; P < 0.05). Hypertension was associated with lowest HMW (OR = 4.50; 95% CI = 1.41-15.84) and HMW/HOMA-IR (OR = 12.13; 95% CI = 2.51-92.93) regardless of obesity. However, HOMA-IR or the HMW/APN was not significant (P > 0.05). In the ROC curve analyses, the HMW and HMW/HOM-IR were more sensitive to detect hypertension in children and adolescents with obesity. Conclusion: Low levels of HMW oligomer and HMW/HOM-IR are associated with hypertension in childhood obesity. Thus, these biomarkers could be clinically useful in identifying hypertension in childhood obesity. What is Known: • HMW has previously been reported as the most biologically active isoform of adiponectin, and lower HMW concentrations are associated with obesity, insulin resistance, and metabolic syndrome in children and adolescents. • HMW/HOMA-IR ratio is a sensitive predictor for metabolic syndrome in adults. What is New: • HMW levels are associated with hypertension in children and adolescents, independently of presence of obesity. • HMW was more sensitive to detect hypertension in children and adolescents with obesity when compared to HMW/HOMA-IR, HMW/APN, APN, APN/HOMA-IR, or HOMA-IR.

Hypertension in obese children is associated with vitamin D deficiency and serotonin dysregulation

BackgroundObesity and hypertension represent serious health issues affecting the pediatric population with increasing prevalence. Hypovitaminosis D has been suggested to be associated with arterial hypertension. Serotonin by modulating nitric oxide synthase affect blood pressure regulation. The biological mechanism by which vitamin D specifically regulates serotonin synthesis was recently described. The aim of this paper is to determine the associations between vitamin D, serotonin, and blood pressure in obese children.MethodsOne hundred and seventy-one children were enrolled in the prospective cross-sectional study. Two groups of children divided according to body mass index status to obese (BMI ≥95th percentile; n = 120) and non-obese (n = 51) were set. All children underwent office and ambulatory blood pressure monitoring and biochemical analysis of vitamin D and serotonin. Data on fasting glucose, insulin, HOMA, uric acid, and complete lipid profile were obtained in obese children.ResultsHypertension was found only in the group of obese children. Compared to the control group, obese children had lower vitamin D and serotonin, especially in winter. The vitamin D seasonality and BMI-SDS were shown as the most significant predictors of systolic blood pressure changes, while diastolic blood pressure was predicted mostly by insulin and serotonin. The presence of hypertension and high-normal blood pressure in obese children was most significantly affected by vitamin D deficiency and increased BMI-SDS.ConclusionsDysregulation of vitamin D and serotonin can pose a risk of the onset and development of hypertension in obese children; therefore, their optimization together with reducing body weight may improve the long-term cardiovascular health of these children.

Hypertension in Children with Obstructive Sleep Apnea Syndrome-Age, Weight Status, and Disease Severity.

Older age, obesity, and obstructive sleep apnea syndrome (OSAS) are known to increase the risk of hypertension in adults. However, data for children are scarce. This study aimed to investigate the relationships between hypertension, age, weight status, and disease severity in 396 children with OSAS. The prevalence rates of hypertension, obesity, and severe OSAS (apnea-hypopnea index ≥10) were 27.0%, 28.0%, and 42.9%, respectively. Weight z-score and apnea-hypopnea index were independently correlated with systolic blood pressure z-score, and minimal blood oxygen saturation (SpO2) was independently associated with diastolic blood pressure z-score. Overall, late childhood/adolescence (odds ratio (OR) = 1.72, 95% CI = 1.05–2.81), obesity (OR, 2.58, 95% CI = 1.58–4.22), and severe OSAS (OR = 2.38, 95% CI = 1.48–3.81) were independent predictors of pediatric hypertension. Furthermore, late childhood/adolescence (OR = 2.50, 95% CI = 1.10–5.71) and abnormal SpO2 (mean SpO2 < 95%; OR = 4.91, 95% CI = 1.81–13.27) independently predicted hypertension in obese children, and severe OSAS (OR = 2.28, 95% CI = 1.27–4.10) independently predicted hypertension in non-obese children. In conclusion, obesity, OSAS severity, and abnormal SpO2 are potentially modifiable targets to improve hypertension while treating children with OSAS.

Polymorphism of genes of arterial hypertension among children with obesity and arterial hypertension

Arterial hypertension (АH) among obese children and adolescents is diagnosed with a frequency of 24,8 — 40 % of cases. The pathogenesis high blood pressure (HB) among childhood obesity continues to be studied in connection with the identification of new genetic and epigenetic factors that determine its course. Polymorphism of genes of arterial hypertension can serve as a reason for maintaining increased vascular tone, even if the nutritional status of the child is optimized. The objective was to study polymorphisms of genes of arterial hypertension AGT: 704, AGТ: 521; AGTR2: 1675; еNOS3:786 among children with obesity and arterial hypertension, depending from the dynamics of blood pressure after courses of diet and physical rehabilitation. Materials and methods. The study has included 50 obese and hypertensive children aged 11—14 years who were prescribed diet and courses of special physical exercises for 6 months. We have compared 2 groups of children: children who have had arterial hypertension after treatment («АH6 month +») and children who had no arterial hypertension after treatment («АH6 month -»). The comparison group has consisted of 34 healthy children with normal body mass index and blood pressure. We have performed clinical and instrumental, laboratory examination, anamnestic assessment of heredity, laboratory analysis of genotypic variants AGT: 704, AGТ: 521; AGTR2: 1675; еNOS3:786 among the studied population of children. Results. Comparative analysis of genotypic variants has showed a disproportionate distribution of alleles depending on the dynamics of blood pressure. Among children o «АH 6 month +» there were a predominance of mutant homozygous alleles of the gene AGTR2 AA (A) 45 % (22 %) and a decrease in the frequency a normal homozygous allele GG 9,0 % (9,6 %). We found a greater affinity of the CC homozygote for AGT 704, the CT heterozygote for AGT521 and the CC homozygote for the eNOS gene for the group of children «АH 6 month +» than among children «AH 6 months -» and healthy children. Conclusion. The revealing of causal polymorphisms of genes of arterial hypertension in obese children will allow predicting the risk of developing stable hypertension and determining treatment.

A ten-year review of childhood obesity in a teaching hospital, South West Nigeria.

Obesity is an important cosmopolitan cause of morbidity in children and adolescence age groups. Information on obesity in this age group in Nigeria is scant. To determine the prevalence of obesity and the associated morbidities seen at the Paediatric Endocrinology clinic of Ekiti State University Teaching Hospital, South West, Nigeria. A retrospective review of all obese children attending the Paediatric Endocrinology clinic. Sociodemographic and other information related to paediatric obesity and associated morbidities were extracted from the case notes. Data obtained was analyzed using Statistical Package for Social Sciences (SPSS) version 20. A total of 21 obese children attended the clinic in the 10 years of study. The 21 children were made of 14 (66.7%) girls and 7 (33.3%) boys, giving a 2:1 female to male ratio. The ages of the children ranged from 1 to 16 years with a mean age of 8.79 ± 4.35 years. Obesity was secondary to a nutritional cause in 16 (76.2%) of the cases and Type 1 diabetes mellitus, Type 2 diabetes mellitus, Cushing's syndrome, Iatrogenic Cushing's syndrome and post-meningitis in the remaining 1 (4.8%) case each. Seventeen (81%) of the children were from the higher socioeconomic class, and the remaining three (19.0%) from lower socioeconomic class. Four (19.0%) of the children had hypertension with their blood pressure (BP) above the 95th percentile for age and sex. Hypertension was more common among the higher socioeconomic group, children older than 10 years and the female gender. This association was not statistically significant. A greater proportion of children with body mass index (BMI) >30 had significantly higher rates of hypertension (P < 0.001). Obesity is a common disease condition amongst children attending paediatric endocrine clinic. Strategies to control obesity and progression of severity of obesity may have a place in reducing the prevalence of hypertension in obese children and adolescents.

P1831ABPM DIFFERENCE BETWEEN OBESE AND NON OVERWEIGHT HYPERTENSIVE CHILDREN

Abstract Background and Aims The goal of our study was to analyze the difference in ABPM pattern in overweight and non overweight hypertensive children Method The ABPM were performed using Spacelab 90207 and recorded over 24h.Readings were taken every 15 minutes while awake,and every 20 minutes while asleep. In both groups were evaluated the 24h MAP,daytime MAP,nocturnal MAP, systolic and diastolic load,mean 24h SBP and DBP. A total of 108 pts were enrolled. Pts were divided in two groups.In the first group 54 pts non overweight with primary hypertension:33 male and 21 female with mean age of 10.4 y. In the second group the obese hypertensive children, with mean age of 10.5 y, were divided into two subgroups according to BMI Z-scores:subgroup 1 BMI Z-score &amp;gt;2&amp;lt;3 n 40 pts (17 f;21m); subgroup 2 BMI Z-score &amp;gt;3 n (4f;10m). Results Systolic load was significantly higher in obese group (p 0,0409).In obese group n.12 were dipper (22,2%).Obese with BMI zscore &amp;gt;3 was all non dipper (n14 ;100%). In the lean group n 26 was dipper (48.1%),and 28 (51.8%) non dipper. 24 h MAP, Systolic and Diastolic load were significantly higher (p 0,0001) in the obese with BMI z score &amp;gt;3 compared to the lean group. Conclusion The statistically significant pathological pattern among obese is the increase inmean PAS and systolic load, as well as the absence of night dipping in severe obese. The increase in systolic load is already evident in obese mild.This gives a significant predictive value of cardiovascular damage to ABPM which increases with the severity of obesity worse.

Predictive Model for Ambulatory Hypertension Based on Office Blood Pressure in Obese Children.

Background: The epidemic of obesity, along with hypertension (HT) and cardiovascular disease, is a growing contributor to global disease burden. It is postulated that obese children are predisposed to hypertension and subsequent cardiovascular disease in adulthood. Early detection and management of hypertension in these children can significantly modify the course of the disease. However, there is a paucity of studies for the characterization of blood pressure in obese children through ambulatory blood pressure monitoring (ABPM), especially in the developing world. This study aims to characterize ambulatory blood pressure in obese children and to explore feasibility of using office BP that will predict ambulatory hypertension.Methods:In the present study, 55 children with a body mass index (BMI) in the ≥95th percentile for age and sex were enrolled in a tertiary care hospital and underwent 24 h of ABPM and detailed biochemical investigations.Results:Ambulatory hypertension was recorded in 14/55 (25.5%; white coat hypertension in 17/29 (58.6%) and masked hypertension in 2/26 (7.69%). For office SBP percentile the area under curve (AUC) was 0.773 (95% CI: 0.619–0.926, p = 0.005) and for office DBP percentile the AUC was 0.802 (95% CI: 0.638–0.966, p = 0.002). The estimated cut offs (Youden's index) for office blood pressure which predicts ambulatory hypertension in obese children were the 93rd percentile for systolic BP (sensitivity-67% and specificity−78%) and the 88th percentile for diastolic BP (sensitivity-83% and specificity-62%).Conclusion:Ambulatory blood pressure abnormalities are highly prevalent among children with obesity. Office blood pressure did not accurately predict ambulatory hypertension. More than half of the children labeled as “hypertension” on office blood pressure measurement in the study were diagnosed to have white coat hypertension (WCH), thus emphasizing the role of ABPM for evaluation of WCH before the child is subjected to detailed investigations or started on pharmacotherapy.

Plasma Fibroblast Growth Factor 23 Is Elevated in Pediatric Primary Hypertension.

Fibroblast growth factor 23 (FGF 23), an endocrine hormone regulating the homeostasis of phosphate and vitamin D, has been shown to play a role in cardiovascular disease. Increased blood FGF 23 is found to be associated with elevated blood pressure in adults. However, measurement of FGF 23 in hypertensive children has not been documented. In this study, a total of 98 children with primary hypertension and 37 controls were recruited, and blood FGF 23 was comparatively investigated. Additionally, FGF 23 levels were compared between the subgroups of patients after hypertensive children were sub-grouped according to their cardiac geometry, hypertension stages, insulin levels, and weight. The case group had a FGF 23 level of 48.99 (16.42), expressed as the median (the interquartile range), significantly higher than the 41.72 (7.05) from the control group (p = 0.0002). While no remarkable differences were observed in FGF 23 levels between non-obese and obese hypertensive children, between patients with stage 1 and stage 2 hypertension, or between patients with normal and high insulin levels; hypertensive children with abnormal cardiac geometry had significantly higher levels of FGF 23 than patients with normal cardiac geometry (p = 0.0085). Our data revealed for the first time that hypertensive children have higher levels of FGF 23. Further studies are needed to examine if lowering FGF 23 improves the cardiac geometry in hypertensive children with higher FGF 23.

Oxidative stress in obese children and adolescents with and without type 2 diabetes mellitus is not associated with obstructive sleep apnea.

Obesity, obstructive sleep apnea (OSA), and type 2 diabetes mellitus (T2DM) are associated with chronic low-grade inflammation and oxidative stress. In adults, increased lipid peroxidation, a marker of oxidative stress, was found in both metabolic syndrome and OSA. Studies on oxidative stress in children with T2DM and OSA are scarce. Plasma oxidized low-density lipoprotein (Ox-LDL) levels were evaluated in obese children and adolescents with/without T2DM, and the contribution of OSA to oxidative stress was investigated. Ten patients with T2DM, 8 with impaired glucose tolerance (IGT), and 20 body mass index-standard deviation score (BMI-SDS)-matched non-diabetic children (controls) were studied. They all underwent overnight polysomnography. Fasting plasma concentrations of Ox-LDL were measured and compared to the glycemic status and to the presence of OSA. Fourteen patients (36%) were diagnosed with OSA and 21 (55%) with hypertension. There were no significant group differences in plasma Ox-LDL levels or between patients with/without OSA. Plasma Ox-LDL levels were significantly higher among patients with hypertension compared to controls (P = 0.01), while they correlated with homeostasis model assessment (P = 0.02), BMI-SDS (P = 0.049), and systolic blood pressure (P = 0.002). The findings of this pilot study suggest that increased lipid peroxidation is associated with insulin resistance and hypertension in obese children and adolescents, while OSA has most likely minor influence.

LB.02.01] HOMA INDEX AS A PREDICTOR OF HYPERTENSION IN A PEDIATRIC OBESE POPULATION

Objective: Find predictors of hypertension in obese children diagnosed with ABPM and office BP Design and method: we studied 20 obese children (age 13 ± 0.9 ys, 11 M 9 F) enrolled in our Pediatric Division, with mean BMI of 30.3 ± 4.3, height 1.53 ± 0.11 and weight 72.2 ± 16.6. We evaluated a clinic visit, blood samples, blood pressure measurements (BP office mean of 3 measurements), 24 h ambulatory blood pressure (ABPM), echocardiogram and intimal media thickness (IMT) of common carotid artery. Results: Mean BP office was: systolic 121 ± 12 mmHg, diastolic 65 ± 10 mmHg; mean 24 h ABPM was: systolic 127 ± 10 mmHg and diastolic 70.2 ± 6.24 mmHg; diurnal systolic ABPM 121.9 ± 10.7mmHg, nocturnal 109.1 ± 10.5mmHg; diurnal diastolic ABPM: 75.1 ± 7.9 mmHg, nocturnal 62 ± 5.6 mmHg. For 24 h ABPM pediatric criteria, 2 patients were >90%percentile for sex, age and height for normal-high blood pressure values and 7 pt were>95% for hypertension criteria. Regardless percentile (%) BP criteria for children we observed that for systolic nocturnal BP 2 subjects were>90% and 7>95% and for diastolic BP 4 subjects>90% and 4 >95%. In general ABPM showed 11 patients as hypertensive, 7 were>95% for systolic and 2>95% only for diastolic. Considering predictors of arterial hypertension in our population we figured out that: (i) HOMA index has a positive correlation with systolic office BP (p = 0.03) and (ii) a borderline correlation with mean systolic ABPM (p = 0.06). Interestingly in our paediatric population, in patients defined as hypertensive for the 95% criteria with the ABPM monitoring, HOMA index was significantly different between hypertensive and non-hypertensive children (p = 0.05) Conclusions: In conclusion our preliminary report show that: (i) ABPM has a better sensitivity in diagnosing arterial hypertension versus office BP measurement and that (ii) HOMA index is an important predictor of hypertension in healthy obese children.

Evaluation of blood pressure in school children aged 12-16 years

Background: Hypertension is considered as a major health issue in developed as well as developing countries and its possible origin during childhood prompts pediatricians to routinely include measurement of blood pressure (BP) as an integral part of pediatric physical examination. The objectives of the study were to evaluate the normal range of blood pressure in adolescent school going students of 12-16 years, prevalence of hypertension and relationship of BP with variables like age, body mass index (BMI), socioeconomic status and family history of hypertension.Methods: A cross sectional study was undertaken for a period of one year in adolescent school children in age groups between 12-16 years. Detailed clinical examination was done in 1060 adolescent school children and BP was recorded in right upper limb and correlation of BP with BMI, family history of hypertension and diabetes were studied.Results: Mean systolic and diastolic pressure showed linear relationship with age. There was a highly statistically significant difference between mean systolic and diastolic blood pressure between lower and middle socio-economic class. Prevalence of obesity in our study was 1.13%, overweight was 7.83%. Prevalence of hypertension in obese children was 33.33% and in overweight children 18.07%. Family history of hypertension and diabetes carry a significant correlation with elevated systolic and diastolic blood pressure in adolescents.Conclusions: This study revealed that socio economic factors play a significant role in determining the blood pressure of the individual. Children of middle class have significantly elevated mean systolic pressure and mean diastolic pressure than low socio-economic groups.

THIRTY-TWO-YEAR DYNAMICS AND PROGNOSTIC SIGNIFICANCE OF BASELINE LEVELS OF SYSTEMIC PRESSURE IN TEENAGE BOYS

Aim . To evaluate the 32-year dynamics and prognostic significance of the baseline levels of arterial pressure (BP) in teenage boys. Material and methods . Thirty-two-year prospective cohort follow-up of males, beginning from the age 11-12 y.o. In 32 years, among 1005 participants, 303 (30,1%) assessed, and the cohort consisted of 290. The investigation included: standard questionnaires; three-time BP measurement; pulse rate; anthropometry; triceps, scapula and abdominal skin folds measurement, waist and hip circumference; total cholesterol measurement, as high density lipoproteides and triglycerides. Results . The prevalence of arterial hypertension slightly declines in 12 to 15 years, and then increases at 17-22 years with high increase at 33 years, with further stabilization. All tracking coefficients (Pearson correlation) for systolic BP (sBP) were statistically significant, but decreased from the age 33 to 43 (from 0,35 to 0,17). For the diastolic BP-5 (dBP5) statistic significance was found only by 22 years, dBP4 — by 33 years. There was significant correlation of sBP and dBP with body mass index and anthropometry. In 30 years, the stabilized increase (fifth quintile) remains by sBP and dBP for every fifth. From the first to the fifth, every tenth switched by sBP and every fifth by dBP. Conclusion . Measurement of BP in childhood and teenage is worthful, as there is significant relation of sBP and dBP in teenage with its adult level. Every fifth teenager with increased BP at childhood remain it in 30 years. Also, every tenth with low BP shows its increase in 30 years. The special attention should be paid for primary prevention of arterial hypertension in obese children and those with raised BP. It is important to search for new markers of prognosis.

In-vitro function of upstream visfatin polymorphisms that are associated with adverse cardiometabolic parameters in obese children.

BackgroundVisfatin is an adipokine associated with glucose and lipid metabolism. We previously reported two visfatin upstream single nucleotide polymorphisms (SNPs), c.-3187G > A (rs11977021) and c.-1537C > T (rs61330082), which were in perfect linkage disequilibrium, in a Singaporean cohort of severely obese children and are associated with visfatin level and adverse cardiometabolic parameters. We aim to functionally characterize the effect of c.-3187G > A and c.-1537C > T SNPs on basal transcriptional activity.MethodsA 1.6 kb and 3.7 kb upstream promoter region of the visfatin gene was amplified by polymerase chain reaction and separately cloned into luciferase reporter vectors. Successful clones were transfected into human embryonic kidney (HEK293T) and human breast carcinoma (MCF7) cells and in-vitro dual-luciferase assay was performed. Electrophoretic mobility shift assay (EMSA) was also conducted to examine the binding affinity between transcription factors and visfatin promoter sequences.ResultsVariant promoter with only c.-1537C > T SNP did not show a change in transcriptional activity as compared to the wild type. However, variant promoter with both c.-3187G > A and c.-1537C > T SNPs showed a statistically significant increase of 1.41 fold (p < 0.01) in transcriptional activity. The longer 3.7kbp visfatin promoter sequence was also shown to have significantly higher transcriptional activity (p < 0.05) as compared to the shorter 1.6kbp visfatin promoter. Both c.-3187G > A and c.-1537C > T variants showed an increased binding with nuclear protein.Discussion and conclusionsWe have demonstrated for the first time that visfatin variant promoter with both c.-3187G > A and c.-1537C > T SNPs result in an increase in transcriptional activity. This supports our previous finding and postulation that these SNPs contribute to elevated visfatin levels which may mediate higher triglyceride levels, severe systolic blood pressure and severe hypertension in obese children. These SNPs may co-operatively affect enhancer or silencer function to regulate transcriptional activity. In conclusion, this study shows that upstream visfatin SNPs could potentially affect phenotypic outcome in obese children through alteration of circulating visfatin level.Electronic supplementary materialThe online version of this article (doi:10.1186/s12864-016-3315-9) contains supplementary material, which is available to authorized users.

Hypertension, lipoprotein subclasses and lipid transfer proteins in obese children and adolescents

Background: Obesity-related childhood hypertension is associated with disturbances of serum lipids, but less is known about distribution of lipoprotein subclasses and activities of proteins involved in reverse cholesterol transport in hypertensive obese children. Our objective was to determine low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subclasses distribution and activities of lecithin:cholesterol acyltransferase (LCAT) and cholesteryl ester transfer protein (CETP) in hypertensive and non-hypertensive obese children.Methods: A total of 40 hypertensive and 25 non-hypertensive obese children were enrolled. Lipoprotein subclasses were assessed by polyacrylamide gradient gel electrophoresis. LCAT and CETP activities were determined as a rate of formation and a rate of transfer of cholesteryl esters.Results: Despite of comparable values of serum lipid parameters, a shift toward smaller LDL and HDL subclasses was observed in hypertensive compared to normotensive obese children. Activities of LCAT were similar, but proatherogenic CETP activities were significantly higher in the hypertensive group (p = 0.036). LCAT/net CETP ratio inversely correlated with relative proportion of small, dense LDL particles (ρ = −0.423; p = 0.025) in the group with hypertension.Conclusions: The results of our study demonstrated a tendency toward altered distribution of lipoprotein subclasses in favor of more proatherogenic particles in childhood hypertension. Also, hypertensive obese children had increased proatherogenic CETP activity.

Screening, diagnosis and treatment of hypertension in obese children: an international policy comparison

Hypertension in obese children may require a different diagnostic and treatment approach from that for children with secondary hypertension, yet there is neither consensus nor a clear guideline. The aim of this study was to assess how obese children with hypertension are currently diagnosed and treated by paediatric nephrologists, what obstacles exist and what can be improved. In the period May–November 2014, an online questionnaire was sent to all members of the European Society for Paediatric Nephrology (n = 2148). Questions focused on current practices and obstacles regarding screening, diagnosis and treatment of hypertension in obese children. A total of 214 paediatric nephrologists responded. Although nearly 100 % agreed that screening of obese children for hypertension is indicated, it was current practice in only 56 % of participating countries; 88 % of respondents diagnosed hypertension with 24-h ambulatory blood pressure measurement. Diagnostics used to rule out causes or consequences of hypertension varied among the respondents; they included, in particular, the use of serum renin/aldosterone, urine sodium/potassium, and dimercaptosuccinic acid scan. Concerning treatment, 45 % of respondents preferred to start treatment with a lifestyle program, 2 % with antihypertensive medication, and 40 % with both. For 73 % of respondents, angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers were the drugs of first choice. The findings of this study emphasize the urgent need for an international guideline for screening, diagnosis and treatment of hypertension in obese children.

Elevated Urinary T Helper 1 Chemokine Levels in Newly Diagnosed Hypertensive Obese Children

Objective:Increasing evidence suggests that T helper (Th) cells play a significant role in the pathogenesis of hypertension. The aim of this study was to evaluate the effect of obesity and anti-hypertensive treatment on urinary Th1 chemokines.Methods:The study groups consisted of three types of patients: hypertensive obese, healthy, and non-hypertensive obese. Pre-treatment and post-treatment samples of the hypertensive obese group and one sample from the other two groups were evaluated for urinary chemokine: regulated on activation, normal T cell expressed and secreted (RANTES), interferon-gamma-inducible protein 10 (IP10), and monokine induced by interferon-gamma (MIG). In the hypertensive obese group, urine microalbumin: creatinine ratio was examined before and after treatment. We recommended lifestyle changes to all patients. Captopril was started in those who could not be controlled with lifestyle changes and those who had stage 2 hypertension.Results:Twenty-four hypertensive obese (mean age 13.1), 27 healthy (mean age 11.2) and 22 non-hypertensive obese (mean age 11.5) children were investigated. The pre-treatment urine albumin: creatinine ratio was positively correlated with pre-treatment MIG levels (r=0.41, p<0.05). RANTES was significantly higher in the pre-treatment hypertensive and non-hypertensive obese group than in the controls. The urinary IP10 and MIG levels were higher in the pre-treatment hypertensive obese group than in the non-hypertensive obese. Comparison of the pre- and post-treatment values indicated significant decreases in RANTES, IP10, and MIG levels in the hypertensive obese group (p<0.05).Conclusion:Th1 cells could be activated in obese hypertensive children before the onset of clinical indicators of target organ damage. Urinary RANTES seemed to be affected by both hypertension and obesity, and urinary IP10 and MIG seemed to be affected predominantly by hypertension.

Pathophysiology of hypertension in obese children: a systematic review.

Hypertension is increasingly common in overweight and obese children. The mechanisms behind the development of hypertension in obesity are complex, and evidence is limited. In order to effectively treat obese children for hypertension, it is important to have a deeper understanding of the pathophysiology of hypertension in obese children. The present review summarizes the main factors associated with hypertension in obese children and discusses their potential role in its pathophysiology. Systematic searches were conducted in PubMed and EMBASE for articles published up to October 2014. In total, 60 relevant studies were included. The methodological quality of the included studies ranged from weak to strong. Several factors important in the development of hypertension in obese children have been suggested, including endocrine determinants, such as corticosteroids and adipokines, sympathetic nervous system activity, disturbed sodium homeostasis, as well as oxidative stress, inflammation and endothelial dysfunction. Understanding the pathophysiology of hypertension in overweight and obese children is important and could have implications for its screening and treatment. Based on solely cross-sectional observational studies, it is impossible to infer causality. Longitudinal studies of high methodological quality are needed to gain more insight into the complex mechanisms behind the development of hypertension in obese children.

Increased activity of MMP-2 in hypertensive obese children is associated with hypoadiponectinemia.

To compare the circulating levels of MMP-2 and TIMP-2 and the MMP-2/TIMP-2 ratio in control, obese, and obese hypertensive children and adolescents and to assess whether hypoadiponectinemia is associated with MMP-2 and TIMP-2 levels and MMP-2/TIMP-2 ratios. Studies were carried out with 53 control, 73 obese, and 29 obese hypertensive children and adolescents in this cross-sectional study. Adiponectin and TIMP-2 concentrations were measured by ELISA. MMP-2 concentrations were measured by gelatin zymography. Multiple linear regression analysis was carried out to assess the effects of adiponectin on MMP-2 and TIMP-2 levels and MMP-2/TIMP-2 ratios. The obese hypertensive group had the lowest adiponectin levels among groups (P < 0.05) while obese subjects had lower adiponectin levels than control subjects (P < 0.05). Obese hypertensive subjects also had higher circulating MMP-2 concentrations than obese subjects (P < 0.05) and had the highest MMP-2/TIMP-2 ratios among groups (P < 0.05). Moreover, obese/hypertensive subjects had the lowest TIMP-2 levels among groups (P < 0.05). A multiple linear regression analysis showed that MMP-2 levels and MMP-2/TIMP-2 ratios are negatively associated with adiponectin levels (P = 0.034 and P = 0.011, respectively) while TIMP-2 levels is positively associated with adiponectin levels (P = 0.013). Increased activity of MMP-2 (MMP-2/TIMP-2 ratio) and reduced TIMP-2 levels may play an important role in clinical hypertension of childhood obesity. Additionally, hypoadiponectinemia may contribute to increased activity of MMP-2 in obese/hypertensive children and adolescents.