Non-obese Hypertensives Research Articles

A CLINICAL COMPARATIVE STUDY OF RENAL PARAMETERS OF OBESE AND HYPERTENSIVE PATIENTS WITH NON-OBESE HYPERTENSIVE PATIENTS

Objective: Obesity is associated with an early onset of glomerulomegaly, hemodynamic changes of a hyper-filtering kidney, and increased albuminuria. It is an important risk factor for incident CKD and increase risk of ESRD. The aim of the present study is to compare the influence of renal parameters among the obese and non-obese hypertensive patients attended to a tertiary care hospital. Methods: The study was conducted on 120 patients who were divided into 4 groups Group ‘O’ comprises of obese individuals; Group ‘OH’, which comprises of 30 obese and hypertensive individuals; Group ‘NO, H’ which comprises of non-obese and hypertensive individuals and Group ‘C’ which comprises of 30 healthy control group having normal BMI. Results: The mean±SD of serum creatinine was 0.88±0.06; 1.13±0.1; 0.7±0.08; 0.7±0.06 of all the 4 groups and the Serum urea mean±SD was 26.4±3.8; 36.6±5.42; 21.2±3.2; 20.4±3.2 and the Serum uric acid mean±SD levels were 4.3±0.64; 4.3±0.56; 3.8±0.3; 3.7±0.26 of all the 4 groups and eGFR values were 139.5±1.8; 95.3±23.20; 116.2±7.4;118.6±6.2 in obese, obese hypertensive, non-obese hypertensive and control subjects respectively. The results showed that there was a significant influence of renal parameters among the four tested groups. Conclusion: The strategies to prevent weight gain and to induce weight loss in patients who are already obese would ultimately reduce the incidence of obesity-mediated renal disease.

Effect of obesity and hypertension on left ventricular geometry and function among asymptomatic Indian adults.

Hypertension & obesity are important independent predictors of cardiovascular morbidity & mortality specifically left ventricular (LV) functions. With the Objectives to examine the effect of obesity & hypertension on echocardiographic parameters of geometry, systolic, and diastolic functions of left ventricle in asymptomatic adults the cross-sectional study was conducted with 100 individuals (60 male & 40 female). Their Blood Pressure & Body Mass Index was recorded following which they were divided into obese normotensives & non-obese hypertensive. Echocardiographic parameters indicating LV geometry and function were recorded. Data was statistically analysed with Unpaired t test considering p value <0.05 as significant. LV geometry and LV systolic function parameters were significantly altered in non-obese hypertensive. Parameters of LV diastolic functions were affected in obese normotensives. 54% of obese normotensives had LV diastolic dysfunction & 58% of non-obese hypertensive had LV diastolic dysfunction. 2% of obese non-hypertensive individuals had LV systolic dysfunction & 6% of non-obese hypertensive had LV diastolic dysfunction. Hypertension significantly affects LV geometry, LV systolic and diastolic function. Obesity affects LV geometry & diastolic functions of LV even in individuals with preserved systolic function.

A COMPARATIVE STUDY OF THE EFFECT OF BODY MASS INDEX ON SYMPATHOVAGAL ACTIVITIES IN HYPERTENSIVE INDIVIDUALS

The rising rates of obesity and hypertension can be traced to a combination of factors including decreased physical activity, increased psychological stress, and increased work-related stress. Sympathetic overactivity is the primary pathophysiologic process in the development of obesity and hypertension, regardless of origin. Many clinical diseases can be traced back to a sympathovagal imbalance, or disruption of autonomic functioning due to sympathetic excess activity and vagal withdrawal. Autonomic dysfunction has been linked to obesity, hypertension, and diabetes mellitus separately. The measurement of heart rate variability (HRV) has become a popular, non-invasive method for studying cardiac autonomic dysfunction quantitatively. The current research sought to answer the question of whether obesity contributes to the worsening of autonomic dysfunction, especially in hypertensive individuals. Adult males and females in their forties and fifties who were patients at the OPD in UPUMS, Saifai, Etawah, India, were enlisted for the study.HRV was measured using the one-minute method while the subjects were in a relaxed state and deep breathing was encouraged. A total of 105 participants were divided into Groups I (obese hypertensive), II (non-obesity hypertension), and III (non-obese normotensive, control). The mean heart rate variability (HRV) of obese hypertension patients was considerably lower than that of non-obese hypertensive patients (p&lt;0.005 at α 0.05 HRV, data provided as Mean± SD inferential statistics by One Way ANOVA and Tukeys Post Hoc test). Our findings suggest that obesity and hypertension may have an additive effect in inducing autonomic dysfunction.

Influence of Obesity on Blood Pressure Responses to Antihypertensive Drug Therapy in an Urban Hypertension Specialty Clinic.

Previous studies have reported that lean hypertensives have worse clinical outcomes than obese hypertensives as obesity confers pharmacological resistance to antihypertensive therapy. We explored whether the higher prescribed doses of antihypertensives in obese hypertensives were adequate for the attainment of similar on-treatment blood pressure (BP) versus leaner hypertensives. A retrospective chart review of predominantly African American females from a deidentified urban referral clinic was conducted (N = 851; median follow-up = 11.3 months). Body mass index (BMI, kg/m2) was categorized as either below or above or equal to 30. Antihypertensive therapeutic intensity score (TIS) was calculated as the total daily antihypertensive dose/maximum United States Food and Drug Administration (USFDA) approved daily dose, summed across all hypertensive drugs. General linear models were used to estimate the significance of continuous variables across BMI categories. At baseline, systolic blood pressure (SBP) was similar between groups (P = 0.14), though 2.7 mm Hg higher in the highest BMI group. Antihypertensive TIS was greater in the highest BMI category at both baseline and end of follow-up (both P < 0.001). After covariate adjustment end of follow-up SBP and diastolic blood pressure was higher in the obese group by 3.4 (0.6-6.1) and 1.8 (0.1-3.53) mm Hg, respectively (P = 0.02, P = 0.04). Attained on-treatment BP is higher in obese than non-obese hypertensives despite greater prescription of antihypertensive medications. Whether even more prescription of medications or other interventions will equalize BP responses relative to non obese hypertensives merits further study.

An echocardiographic study of the effect of obesity on systolic and diastolic functions of the left ventricle in hypertensive adults

Objectives: The objectives of the study were to examine the effect of obesity on echocardiographic parameters of systolic and diastolic functions of the left ventricle (LV) in asymptomatic hypertensive adults. Materials and Methods: A cross-sectional study was conducted with 100 individuals (65 males and 35 females). Their blood pressure and body mass index were recorded following which they were divided into obese hypertensives and non-obese hypertensives. Echocardiographic examination was done, and parameters indicating LV geometry and function were recorded. Data were statistically analysed for differences. An unpaired t-test was used considering P &lt; 0.05 as a significant value. Results: Echocardiographic parameters of LV diastolic function were significantly altered in obese hypertensives compared to non-obese hypertensives (P &lt; 0.05). About 58% of non-obese hypertensives and 78% of obese-hypertensives had LV diastolic dysfunction. About 6% of non-obese hypertensives and 8% of obese-hypertensives had LV systolic dysfunction. Conclusion: Obesity in hypertensive individuals adds risk for diastolic dysfunction. The number of subjects falling into categories of mild-to-moderate diastolic dysfunction was considerably higher in the obese hypertensives compared to the non-obese hypertensives.

Comparison of renal profile in obese hypertensive and non-obese hypertensive patients at a Tertiary Care Hospital – A two year study

Introduction: Obesity is a nutritional disorder and associated with excess fat deposition due to altered balance between energy intake and consumption. Obesity and obesity related hypertension are identified as risk factors in development of diabetes and chronic kidney disease. Obesity alters the hemodynamic functions of organs and is a threat for development of cardiovascular diseases, renal failure and peripheral arterial disease. Objectives: The objective of the present study was to compare the renal profile among healthy individuals, obese individuals, obese with preexisting hypertension and obese individuals without hypertension. Materials and Methods: A prospective cross sectional observational study was conducted at ACSR government medical college and hospital, a tertiary care hospital for a period of two years from October 2014 to September 2016. 120 subjects were divided into 4 groups with 30 in each group, healthy, obese, non obese hypertensive and obese hypertensives. Results: All the measured variables in all the four groups of the study were expressed as mean ± standard deviation. BMI of 32.1 ± 2.1 was observed in obese group whereas 22.1 ± 3.1 was observed in healthy group. Statistically significant correlation was found with BMI, S. urea, S. creatinine, S. uricacid and estimated Glomerular filtration rate (‘p’ value

Effect of Obesity on Sympathovagal Activities in Hypertensive Indian Population.

Decreased physical activity, increased psychosocial stress and work stress have contributed to the increased prevalence of obesity and Hypertension (HTN). Irrespective of the aetiology, sympathetic over activity has been recognized as the main pathophysiologic mechanism in the genesis of obesity and HTN. Sympathovagal imbalance or dysregulation of autonomic functions owing to sympathetic over activity and vagal withdrawal is reported to be the basis of many clinical disorders. Obesity, hypertension and diabetes mellitus are known to be associated with dysregulation of autonomic functions independently. Heart Rate Variability (HRV) has emerged as a practical, non-invasive tool to quantitatively investigate cardiac autonomic dysregulation. The present study was undertaken to ascertain whether obesity has any effect on further disruption of autonomic functions particularly in hypertensive patients. A total of 96 male and female adults aged between 40-50 years visiting the Primary Health Centre, Yelwala, Mysuru district, India were recruited for this study. They were grouped in to 3 (n=32) as Groups I (Obese hypertensive), II (non-obese hypertensive) and II (non-obese normotensive, control), HRV was determined using the One minute during deep breathing method. Data were presented as Mean ± SD, inferential statistics was by One Way ANOVA and Tukey's Post Hoc test p value <0.005 at α0.05 HRV was significantly decreased in obese hypertensive patients compared to the non-obese hypertensive patients. Our present study supports that obesity and hypertension probably has additive effect in causing autonomic dysregulation.

PP.24.12] OBESE HYPERTENSIVE PATIENTS HAVE MORE OFTEN SIGNS OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND ARTERIAL STIFFNESS COMPARED WITH NON- OBESE HYPERTENSIVE OF THE SAME AGE

Objective: BACKGROUND: obese hypertensive patients (PHTAO), generally have a higher cardiovascular risk than non-obese hypertensives (PHTA), with morbidity also increased, however, have few data on diastolic dysfunction and arterial stiffness (ACE) in these patients, so we consider justified a study on these factors. OBJECTIVES: to compare the frequency of diastolic dysfunction and measure arterial stiffness in PHTAO and PHTA of the same age and with controlled ambulatory blood pressure figures. Design and method: MATERIAL and METHODS: We have studied to 95 HTAO males with average ages of 67 ± 5 years old, and an body mass index (BMI) over 30 kg / m2, and compared with 90 PHTA males of 66 ± 7 years old, and a BMI < 30, who received treatment for keeping the blood pressure (BP) < 140 / 90 according to treatment established by their family doctor. ll of them were submitted to an standart Echocardiogram to measure the e/a index (less 1) of mitral valve flow and left ventricle mass (LVM gr/m2), as well as a study of AS measuring the augmentation index (AIx) and pulse wave velocity (PWV) using the device O-mobil - graph ©, German. The results were compared and shown in the following table and comments*means p value less than 0.05. Conclusions: CONCLUSIONS: PHTAO, have a less adequate control of TA especially diastolic with standard therapy compared to PHBP. We observed in our data a significant increase in signs of diastolic dysfunction and LVM, as well as signs of arterial stiffness, which assigns a greater risk to these PHTAO compared to the other group, so we should increase our efforts to better control of obesity in our patients with elevated BP.

Study of Microalbuminuria and hs-CRP in Non-obese and Obese Normotensive and Hypertensive Males and Evaluation of Microalbuminuria and hs-CRP Changes according to the Stages of Hypertension &amp; Grades of Hypertensive Retinal Changes

Aims & Objectives: To measure Microalbuminuria and hs-CRP in obese and non-obese male hypertensive patients and control groups and to correlate their levels with various stages of hypertension and different grades of hypertensive retinal changes. Men have higher prevalence of hypertension (29.4%) than women (26.5%)[1] Materials & Methods: The study was conducted among 60 normotensive individuals and 60 hypertensive individuals over a period of 6 months on OPD basis. All individuals were males in the age group of 40-60 years. Blood samples were collected and estimation of plasma glucose, urea, creatinine, lipid profile, hs- CRP and Urinary microalbumin were done. Results: The mean value of microalbuminuria and hs- CRP were higher among obese hypertensives than obese controls and were statistically significant. The changes in the mean value of microalbuminuria and hs-CRP within the different stages of hypertension were highly significant. Similarly the correlation of microalbuminuria and hs-CRP within the different grades of hypertensive retinal changes were highly significant. Conclusion: The serum level of hs-CRP and urinary microalbuminuria were elevated in hypertensive patients. The increase of both hs- CRP and microalbuminuria were significantly higher in obese hypertensives than non-obese hypertensives. Microalbuminuria & hs CRP levels correlate with various grades of hypertensive retinal changes.

Assessment of Early Cardiovascular Risk in Children and Adolescents with Essential Hypertension.

The aim of our study was to investigate some early markers of hypertensive target organ damage in hypertensive children and adolescents, and to detect those showing most prominent clinical significance. We included 100 children with essential hypertension (EH) and 50 age-matched healthy control children, and evaluated left ventricular mass (LVM), intima-media thickness in the carotid arteries (IMT), pulse wave velocity (PWV), microalbuminuria, biochemical parameters and some adipokines. Statistically significant differences between the 2 groups were observed for HDL-cholesterol, LDL-cholesterol, triglycerides, insulin, uric acid, glucose, apolipoprotein A1, and total adiponectin. The mean values of IMT, PWV and LVM were greater in hypertensive children, but only the differences in IMT and LVM were statistically significant. In addition, hypertensive children showed significantly higher values of AoSP (aortic systolic pressure), AoPP (aortic pulse pressure) and AIx@75 (augmentation index corrected for heart rate of 75 b.p.m.). Metabolic syndrome was diagnosed in 31% of hypertensive children. A significant number of children with EH have early target organ changes as well as other risk factors, including metabolic syndrome, especially obese ones. However, IMT, LVM and some parameters of arterial stiffness have been found to be early markers in both obese and non-obese hypertensives. In addition, adipokines and coagulation factors seem to be important in obese hypertensives.

Increased Levels of Inflammatory Marker hsCRP, MDA and Lipid Profile in Non-obese Hypertension Subjects

Introduction: High sensitive C-reactive protein (hsCRP) is a very sensitive marker of inflammation, which is synthesized in the liver and has been a widely used biomarker for risk stratifying in Cardio vascular disease (CVD). It is positively correlated with abdominal fat and closely correlated with increased risk of cardiovascular events and obesity had the predominant association with cytokine levels. Obesity induces systemic oxidative stress and causes dysregulation of adipo cytokines and development of metabolic syndrome. In our study, we investigated hsCRP levels in non-obese hypertensive subjects on treatment and its relationship with oxidative stress and lipid profile. Methods: Patients with secondary hypertension, past history of stroke, coronary artery disease, myocardial infarction, and diabetes mellitus were excluded. Serum lipid profile and thiobarbituric acid reactive substances, hsCRP were estimated in these patients by standard procedures and the values were compared with healthy controls. Totally 160 subjects were included in the study.115 were considered as Hypertension with blood pressure >140/90 mmHg and 45 as healthy controls after obtaining consent. Results: There is significant difference in hsCRP levels between study groups, and hsCRP levels correlate with blood pressure. The level of MDA and hsCRP levels were significantly increased in hypertensive subjects compared to control group. Conclusion: Our study shows that even in non-obese hypertensive subjects there was significant increase of hsCRP, LDL Cholesterol. Hence elevated hsCRP levels in addition to lipid profile screening may be a valuable tool for prediction of CVD risk in hypertensive subjects.

PS 06-04 CLINICAL CHARACTERISTICS OF HYPERTENSION WITH OBESITY IN KOREA

Objective: To investigate the characteristics, control rate, and factors affecting blood pressure (BP) control in treated hypertensive patients with obesity in Korea. Design and Method: The Korean hypertension registry (KorHR) is an on-going prospective nation-wide multicenter (15 teaching hospitals) cohort study since 2013. As of Jan 2016, the interim analysis of 1,318 consecutive subjects was performed to understand the baseline characteristics of the population. Obesity was defined as body mass index (BMI) ≥ 25 kg/m2). Results: Of all cohort patients, we selected 430 patients taking antihypertensive drug who have visited clinic more than once. Obesity hypertension (Ob-HT) group (232, 54%) was younger (54.9 ± 11.2 vs. 57.4 ± 11.2 year, p = 0.029) and fatter (28.1 ± 2.6 vs. 23.1 ± 1.5 kg/m2, p < 0.001), included more men (63.4% vs. 49.0%, p = 0.003) and dyslipidemia (60.3% vs. 47.5%, p = 0.009) and had the higher level of hemoglobin, hematocrit, glycated hemoglobin and uric acid than non-obese hypertension (nonOb-HT) group. Ob-HT was treated with more antihypertensive drugs (1.9 ± 0.7 vs. 1.7 ± 0.8, p = 0.007) usually in combination (69.4% vs. 53.0%, p = 0.001). There was no significant group difference regarding systolic and diastolic BP (130.9 ± 12.9 vs. 130.6 ± 14.9 mmHg; 79.7 ± 11.3 vs. 77.8 ± 10.4 mmHg) and BP control rates (73.6% vs. 70.4%). Among antihypertensive drugs, angiotensin receptor blocker was most frequently used (81.9%) in Ob-HT but calcium channel blocker (68.7%) in nonOb-HT. Although there was no significant difference in clinical characteristics between patients with controlled and uncontrolled BP in nonOb-HT group, uncontrolled BP patients in Ob-HT group were younger (50.5 ± 11.8 vs. 56.5 ± 10.6 year, p < 0.001) and heavier (79.4 ± 11.4 vs. 75.9 ± 11.2 kg, p = 0.032). Conclusions: Ob-HT group consisting of more than half of treated hypertension was younger and male gender was more prevalent in the group. Although the overall BP control rate was relatively high regardless of obesity, the younger and much heavier patients were associated with poor BP control in Ob-HT. Those patients need to be received more focus on the treatment.

Stable Nitric Oxide Metabolites Levels in Hypertensive Patients With Obesity and High Leptin Level

to investigate levels of the stable nitric oxide metabolites (NOx) in hypertensive patients with obesity and hyperleptinemia. We examined 124 untreated patients (45 men and 79 women) with essential hypertension (EH) (mean age 51.4+/-6.5 years, mean hypertension duration 8.5+/-7.6 years, 64% with visceral obesity) and 25 healthy volunteers (10 men and 15 women with comparable age). NOx levels were significantly higher in hypertensives (43.18+/-21 mol/l) then in controls (28.3+/-9.6 mol/l; p=0.01). Obese hypertensives had lower NOx concentration than nonobese hypertensives (38.8+/-17.9 and 48.5+/-24.7 mol/l, respectively; <0.05). With increase of degree of obesity NOx levels decreased significantly (r=-0.3; p<0.05). NOx levels correlated with presence (r=-0.44; p<0,05) and degree of obesity (r=-0.3; p<0.05). Hypertensives with high leptin levels had lower NOx concentration (29+/-12.2 mol/l), compared to hypertensives with normal leptin levels (34. 7+/-10.5 mol/l) (p<0.05).

Влияние компонентов метаболического синдрома на уровень стабильных метаболитов оксида азота у больных эссенциальной гипертензией

Objective. To investigate levels of the stable nitric oxide metabolites (NOx) in relation to different components of the metabolic syndrome (MS) in essential hypertension (EH).Methods. We examined 124 untreated patients with EH and 25 healthy volunteers with comparable age.Results. NOx levels were significantly higher in hypertensives (43.18±21, mol/l) then in controls (28.3±9.6 mol/l); p <0.05. In patients with hyperglycemia NOx concentration was significantly higher (46.5±23.9 mol/l) than in those without it (38.6±18, mol/l); р <0.05. NOx levels correlated with blood glucose levels (r=0.32, p <0.05). Obese hypertensives had lower NOx concentration than nonobese hypertensives (38.8±17.9 and 48.5±24.7mol/l accordingly; р <0.05). NOx levels correlated with the presence (r=-0.44, p <0.05) and degree of obesity (r=-0.3, p <0.05). NOx levels were significantly lower in patients with MS (31.6±11.3 and 47.05±20.7 mol/l accordingly; р <0.05). NOx levels decreased with the increase of the quantity of MS components ( р <0.05). NOx levels correlated with the amount of MS components (r=-0.38, p <0.05). Hypertensives with high leptin levels had lower NOx concentration (29±12.2 mol/l), compared to hypertensives with normal leptin levels (34.7±10.5 mol/l); p <0.05.Conclusion. Hypertension per se and hyperglycemia increase NOx levels, whereas MS and its essential signs like visceral obesity and high plasma leptin level decrease NOx levels.

Abstract 169: Stable Nitric Oxide Metabolites Levels and Their Relation to the Metabolic Syndrome Components in Essential Hypertension

Objective: To investigate levels of the stable nitric oxide metabolites (NOx) in relation to components of the metabolic syndrome (MS) in essential hypertension (EH) Methods: We examined 124 untreated patients with EH (mean age 51.4 ± 6.5 years, mean hypertension duration 8,5±7,6 years) and 25 healthy volunteers with comparable age (47.2 ± 7.8 years, p&gt;0,05). Plasma leptin levels were measured by radioimmunoassay, plasma NOx - by spectrophotometry. Results were processed with Statistica 6.0 software. Results: Visceral obesity had 64% of hypertensive patients, dyslipidemia - 80.6%, hyperglycemia - 41,6%, MS - 24%. In 32% the MS diagnosis was based on the presence of two additional criteria, in 68% - on three. NOx levels were significantly higher in hypertensives (43,18±21, μmol/l) than in controls (28.3 ± 9.6 μmol/l) ( p = 0.01). In patients with hyperglycemia NOx concentration was higher (46,5 ± 23,9 μmol/l) than in those without it (38,6±18, μmol/l)(p&lt;0,05). NOx levels correlated with blood glucose levels (r=0,32, p&lt;0,05). NOx concentration did not differ between hypertensives with or without dyslipidemia (43,2±22,2 and 42,05±21,1 μmol/l, accordingly p&gt;0,05). Nonobese hypertensives had lower NOx concentration than obese hypertensives (38,8±17,9 and 48,5±24,7 μmol/l, p&lt;0,05). NOx levels correlated with the presence (r=-0,44, p&lt;0,05) and degree of obesity (r=-0,3, p&lt;0,05). NOx levels were lower in patients with MS (31,6±11,3 and 47,05±20,7 μmol/l, p&lt;0,05). NOx levels decreased with the increase of additional MS criterias: 37,99 ± 12,6 μmol/l in the presence of 2 and 28,3 ± 9,6 μmol/l in the presence of 3 criteria (p&lt;0,05). NOx levels correlated with the amount MS components (r=-0,38, p&lt;0,05). Hypertensives with high leptin levels had lower NOx concentration (29 ± 12,2 μmol/l), compared to hypertensives with normal leptin levels (34,7±10,5 μmol/l) (p&lt;0,05). Conclusion: In essential hypertension NOx metabolism differs in relation to metabolic status. Hypertension per se and hyperglycemia increase NOx levels, whereas MS and its essential signsas visceral obesity and high plasma leptin level decrease NOx levels.

ISP27: Omega 3 PUFA chain length: a key factor of their efficiency on cardiovascular risk factors in experimental metabolic syndrome

Background and aims The impact of dietary n-3 polyunsaturated fatty acids (PUFA), on cardiometabolic risk prevention was evaluated according to chain length, in two rat models of non-obese insulin resistance and hypertension. Materials and Methods Fructose-fed rat was used as a model of acquired metabolic syndrome (MS) and spontaneously hypertensive rat (SHR) rat as a model of inherited MS. The rats were submitted to a diet containing either no n-3 PUFAs (control) or α-linolenic acid (ALA) as single n-3 PUFA source or a mix of ALA and its two main longer chain metabolites (LC), eicosapentaenoic and docosahexaenoic acids. During the dietary period, glucose and insulin tolerance tests were performed and serum triglycerides concentration was quantified. Arterial blood pressure was evaluated punctually by tail-cuff or continuously by implanted telemetry. After 10 weeks of feeding, the fatty acid (FA) composition of insulin-sensitive tissues was analysed. Results The 2 experimental models developed insulin resistance and hypertension, associated to an alteration of the specific FA pattern in insulin sensitive tissues. Insulin resistance was also associated to a high cardiovascular risk as evaluated by the increase in blood pressure parameters and especially by the increase in pulse pressure in the fructose-fed rats. LC n-3 PUFA significantly affected the development of insulin resistance, impaired glucose tolerance, blood pressure rise and hypertriglyceridemia, in relation with a strong limitation of the FA composition in the insulin sensitive tissue phospholipids. Conversely, ALA alone affected only hypertriglyceridemia. Conclusion Whatever the etiology of insulin resistance, the significant beneficial effects of n-3 PUFAs on the prevention of cardiometabolic risk factors can be attributed to the long chain n-3 PUFAs but not to the precursor.

Cardiovascular risk in nonobese hypertensive adolescents: a study based on plasma biomarkers and ultrasonographic assessment of early atherosclerosis

The objective of this study was to investigate the vascular status, left-ventricular mass and biomarkers of endothelial activation in hypertensive (HT) adolescents, with particular attention to comparing nonobese with obese patients. Seventy-nine newly diagnosed HT adolescents aged 15.1±2.1 years (divided into 34 nonobese and 45 obese) were compared with 35 healthy volunteers. Intima-media thickness (IMT), flow-mediated dilation (FMD) and left-ventricular mass index (LVMi) were determined using ultrasound. Adhesion molecules and inflammatory interleukins (ILs), together with lipids and insulin resistance (HOMA), were also studied. HT obese adolescents had higher triglycerides, HOMA, and elevated levels of interleukin-6, tumor necrosis factor-α, soluble intercellular adhesion molecule-1 and soluble E-selectin compared with controls and nonobese HT patients. FMD was lower in HT groups (8.5±4.5% in nonobese, P=0.004; 8.1±4.9%, P=0.01 in obese vs 12.5±4.9%; in control), and IMT was higher (0.52±0.06 mm, P<0.001 in nonobese; 0.54±0.05 mm, P<0.001 in obese vs 0.42±0.05 mm in control). Higher LVMi was found in both HT groups, with the highest value in the nonobese group being 37.8±5.3 g m(-2.7) vs 28.4±5.3 g m(-2.7) in controls (P=0.003). In conclusion, nonobese HT adolescents had the same early cardiovascular deteriorations assessed ultrasonographically as their obese HT peers, although metabolic alterations and endothelial activation measured as plasma biomarkers were more pronounced in obese individuals. The potential mechanisms of early atherosclerosis in nonobese HT adolescents need further evaluation in prospective studies because these factors may differ considerably from those found in young obese individuals with HT.

SINGLE-DRUG THERAPY FOR HYPERTENSIVE PATIENTS WITH NORMAL WEIGHT, OVERWEIGHT, AND OBESITY – COMPARISON OF BMI-RELATED DIFFERENCES IN BLOOD PRESSURE RESPONSE: PP.34.369

Background: Little evidence from the article show body-weight-related differences of response to single-drug antihypertensive therapy. Objective: To investigate BMI-related differences in blood pressure (BP) response to single antihypertensive drug in a community-based, double-blind, active-controlled, randomized prospective clinical trail. Methods and Results: The study was conducted in 7 rural communities in Henan, China. In total, 3535 untreated hypertensive patients, aged 40–75 years, were recruited. Subjects were randomized to 1 of 4 drug groups: hydrochlorothiazide (HCTZ), atenolol, nifedipine, and captopril. Duration of the study was 8 weeks. Patients in each treatment group were stratified into 4 categories of BMI: thin, normal weight, overweight, and obesity. BP response and BP control rate were compared among normal weight, overweight, and obesity groups. In HCTZ, atenolol, or captopril treatment group, obesity predicted increased uncontrolled systolic blood pressure (SBP) (adjusted OR, 1.866, 95%CI: 1.084–3.213, p < 0.05; OR, 2.393, 95%CI: 1.262–4.541; p < 0.01; OR, 1.817, 95%CI: 1.130–2.921, p < 0.05; respectively). And also in those 3 single-drug groups, adjusted means of SBP reductions were significant lower through obese hypertensive to non-obese hypertensive. No significant BMI-related difference in BP response to nifedipine was found. Conclusions: The study demonstrates that HCTZ, atenolol, and captopril are less effective in hypertensives with obesity than with normal weight when used as monotherapy. But the same effect was not found on BP response to nifidepine. These data may help to develop the guidelines for obesity-associated hypertension. Whether BMI-related differences in long-term outcomes of 4 single antihypertensive drugs would exist, is unknown, and would require further study.

Obesity and the Prevalence and Management of Hypertension in Ontario, Canada

We evaluated the association of body weight with the prevalence of hypertension by age and sex, as well as the treatment and control rates in obese and nonobese hypertensives among adults in the province of Ontario, Canada. Cross-sectional, population-based survey of 2,510 adults, 20-79 years of age representative of the Ontario population of 7,996,653. Height, weight, arm and waist circumference, and blood pressure (BP) were directly measured by a trained nurse. Prevalence of obesity (body mass index (BMI) > or =30) increased from 16% in the 20-39 years age-group to 33% in the 60-79 years age group, similarly in men and women. Prevalence of hypertension increased as BMI and age increased: in the older age group (60+) from 36% in the lean to 51% for the overweight, 59% in the obese stage I, and 68% in the obese stage II/III. Prevalence of self-reported diabetes followed a similar pattern. Presence of other risk factors (diabetes and dyslipidemia) was independently associated with higher hypertension rates. Treatment and control rates of hypertension varied by BMI and gender. Lean hypertensive males had the lowest control rates (42%) and the highest systolic BPs compared to overweight (79%) and obese (64%) males. This difference was not apparent in females. Obesity is associated with markedly higher prevalence of hypertension and diabetes with age. If obesity per se is indeed a contributing factor, public health strategies to reduce the obesity epidemic would also markedly reduce the burden of hypertension and diabetes.

Obese and Nonobese Patients With Essential Hypertension Show Similar N-terminal proBNP Plasma Levels

Multiple studies have focused on the influence of obesity on natriuretic peptide levels. However, the effect of obesity on amino-terminal propeptide of B-type natriuretic peptide (NT-proBNP) levels in hypertensive (HT) patients remains uncertain. We studied 252 asymptomatic patients (60 +/- 13 years, 136 men) with essential HT. A routine physical examination, anthropometry, laboratory analyses, echo-Doppler study, and NT-proBNP level determination were performed. NT-proBNP levels were similar in both obese and nonobese HT (median 56 (25-130) pg/ml vs. median 51 (26-129) pg/ml, P = 0.488). No significant differences were found in obese or nonobese patients with left ventricular hypertrophy (LVH) (median 135 (73-425) pg/ml vs. median 151 (64-274) pg/ml, P = 0.597). The area under the curve was 0.89 +/- 0.03 for NT-proBNP to diagnose LVH in the obese HT patients and 0.88 +/- 0.03 in the nonobese. A logistic regression analysis showed that age, gender, and left ventricular mass index (LVMI) were independent predictors of NT-proBNP levels. Body mass index (BMI) was not significantly associated with NT-proBNP in LVH HT patients. Obesity is not statistically associated with NT-proBNP levels in HT asymptomatic patients. The same results were observed in our group of patients with LVH. These data are in contrast with those previously found in heart failure, and raise questions about the role of obesity per se as primary cause of decreased NT-proBNP levels in other pathophysiological conditions.