An increasing prevalence of obesity-related hypertension is observed in the youth and may have severe consequences for future cardiovascular disease development. Previous studies portrayed leptin as a potential factor involved in obesity-related hypertension development. In order to understand leptin's contributions to early cardiovascular deterioration, we investigated leptin and its associations with measures of autonomic activity, endothelial activation, and blood pressure in young healthy black and white men and women. We included 820 participants (aged 20-30 years) and determined serum leptin and endothelial cellular adhesion molecules. We measured 24-h blood pressure, heart rate, and heart rate variability components. In multivariate-adjusted regression analyses, we found consistent associations between markers of autonomic activity (such as 24-h heart rate, day and night-time heart rate as well as heart rate variability total power) and leptin in both white (all p≤0.001) and black men (all p≤0.040). These findings were absent or less prominent in women, despite their almost 10-fold higher leptin levels than men. Only in white men, 24-h diastolic blood pressure was associated with leptin (Std β=0.37; p=0.006). This association was found to be partly mediated by autonomic activity (24-h heart rate variability total power). No independent associations were observed between leptin and markers of endothelial cell activation, irrespective of race or gender. Leptin's independent association with autonomic neural activity in a young apparently healthy population suggests an early influence of leptin on autonomic function and future blood pressure elevation especially in men.

Background and aim Information regarding the effect of leptin on the vasculature in young healthy adults at risk for cardiovascular disease development is limited. We therefore examined the associations between measures of subclinical atherosclerosis (carotid intima‐media thickness, carotid cross‐sectional wall area), large artery stiffness (pulse wave velocity) and a measure of endothelial dysfunction (von Willebrand factor [vWF]) with leptin in young healthy men and women. Methods In a cross‐sectional study in South Africa involving 820 normotensive individuals (337 men and 483 women) aged 20‐30 years, we measured carotid intima‐media thickness, carotid cross‐sectional wall area, pulse wave velocity, vWF from citrated plasma and leptin from serum. Results Despite sevenfold higher leptin in women than men (P < 0.001), only in young healthy men, we observed negative, independent associations between measures of carotid wall thickness (carotid intima‐media thickness: R2 = 0.05; β = −0.20; P = 0.036; carotid cross‐sectional wall area: R2 = 0.05; β = −0.20; P = 0.035) with leptin in multivariable‐adjusted regression analyses. When reviewing these associations across body mass index categories, we found an association to be evident only in overweight men (carotid intima‐media thickness: R2 = 0.15; β = −0.41; P = 0.007; carotid cross‐sectional wall area: R2 = 0.21; β = −0.47; P = 0.002). No association was observed in the women or between pulse wave velocity and vWF with leptin. Conclusion In young healthy men, we found a beneficial inverse association between measures of carotid wall thickness and circulating leptin, thereby supporting a potential vascular protective role of leptin.

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Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension (ISH) aimed at raising awareness of high BP and acting as a temporary solution to the lack of screening programmes worldwide. As part of MMM, screening in South Africa in 2017 and 2018 revealed that approximately one-third of adults had hypertension, that only half of hypertensives were receiving anti-hypertensive therapy and that only a third of those with hypertension had controlled BP. These data highlight the need for continued screening and awareness campaigns. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2019. Blood pressure measurements, the definition of hypertension and statistical analyses followed the MMM protocol. The sites screened were general populations, pharmacies, and university campuses in preference to hospitals and clinics, aiming to raise awareness, and allow access to screening to those less likely to be aware of their BP. Of the 4727 individuals (age 40.9 ± 18.1 years) screened, 31.9% had hypertension. Of those with hypertension, only 42.5% were aware and 36.1% were receiving treatment for hypertension. A large proportion (48.5%) of individuals receiving antihypertensive medication had uncontrolled BP. In conclusion, the high proportions of individuals unaware of their hypertension and with uncontrolled BP highlight the need for hypertension awareness campaigns and more rigorous management of hypertension.

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