ES prevalence in Lima's public transportation drivers is in a medium range as suggested by previous regional studies.

BackgroundBlack women have one of the highest prevalence rates of hypertension and obesity in the United States. We previously reported that sympathetic activation induced by obesity is a significant contributor to hypertension in white patients. It is unknown whether sympathetic activity similarly contributes to hypertension in obese black women.Methods and ResultsWe studied 42 obese women (16 white, body mass index 36±4 kg/m2, 44% with hypertension; 26 black, body mass index 35±4 kg/m2, 46% with hypertension). Antihypertensive medications were discontinued for 2 weeks before the day of the study. All patients underwent complete autonomic blockade with trimethaphan at a dosage of 4 mg/min. Resting sympathetic activity determined from muscle sympathetic nerve recordings was similar between obese black women with hypertension and those with normotension. In whites, sympathetic activity was elevated in obese patients with hypertension compared with normotension; the decrease in mean arterial blood pressure produced by trimethaphan was greater in obese white patients with hypertension compared with those with normotension (−26.8±9.7 mm Hg versus −14.8±7.9 mm Hg, P=0.02). In contrast, there was no difference in the depressor responses induced by trimethaphan between obese black women with hypertension and those with normotension (−15.5±10.5 mm Hg versus −12.3±10.2 mm Hg, P=0.45). Mean arterial blood pressure remained elevated in obese blacks with hypertension compared with those with normotension during trimethaphan infusion (83.7±15.0 mm Hg versus 71.7±9.8 mm Hg, P=0.02). Heart rate increased similarly with trimethaphan between white (P=0.11) and black (P=0.76) women with hypertension and normotension.ConclusionsThese findings suggest that sympathetic activity does not contribute to hypertension in obese black women and provide further evidence for racial differences in hypertension mechanisms.

BackgroundFlow‐mediated dilation (FMD) is used to assess endothelial function through changes in vascular diameter after hyperemia. High‐fat meal (HFM) has been shown to induce endothelial dysfunction; recent studies, however, reported conflicting results in obese African American women (AAW). Differences in the method used to analyze FMD may explain these discrepancies.Methods and ResultsIn protocol 1, we assessed the time course of FMD and compared the repeatability of FMD using the individual maximum peak dilation (FMD peak) and the dilation at 60 seconds (FMD 60). Sixteen AAW (age, 42±10.4 years; body mass index [BMI], 39±5.8 kg/m2) were studied on 2 occasions, 4 weeks apart, under fasting conditions (study 1 and study 2). In protocol 2, we used the most repeatable measurement from protocol 1 to assess changes in endothelial function after an HFM in 17 AAW (agen 42±11.1 years; BMIn 38±5.6 kg/m2). We found that FMD peak was the most repeatable measurement (N=16; study 1, 5.31±3.12% and study 2, 5.80±2.91%; r=0.94). After an HFM, the baseline brachial artery diameter significantly increased at 2 hours (0.10 mm; 95% confidence interval [CI], 0.01–0.18; P=0.03) and at 4 hours (0.17 mm; 95% CI, 0.09–0.25; P<0.001). At 2 hours, the FMD peak decreased compared with pre‐HFM (−1.76; 95% CI, −3.55–0.02; P≤0.05).ConclusionsThe individual's maximum peak dilation after hyperemia is the most consistent measure to assess the effect of an HFM on endothelial function. Endothelial dysfunction occurred at 2 hours after an HFM in AAW.Clinical Trial Registration URL: https://clinicaltrials.gov/ Unique identifiers: NCT01334554 and NCT02126735.

We present the case of a healthy young man who developed pyogenic myositis, an infection that is rare in the USA. He had no prior medical conditions except for an obsessive-compulsive disorder and skin picking disorder resulting in multiple superficial skin infections. He presented to our hospital with acute back pain. He was found to be septic with fever, tachycardia and elevated white cell counts. Imaging revealed evidence of myositis in the gluteal region. He was treated with antibiotics and fully recovered. It is likely that the skin picking disorder and the recurrent superficial skin infections are responsible for the development of this infection.