The relationship between body fat indexes, lipid and lipoprotein levels, and blood pressure was studied in 2230 children, each examined during 1973, 1976, and 1978. The children were grouped with the use of seven percentile (P) intervals of triceps skinfold thickness that were specific for race, sex, and age; cardiovascular risk factor variables were assessed over time. Of the 238 children initially in the lowest P group (<15P), 44% remained there, and 65% had skinfold thicknesses below 30P on the three occasions. Of the 352 children in the highest P group ('85P), who were considered to be very obese, 39% remained at this level while 69% remained at 70P or greater. Of the 366 considered to be obese (.70, <85P), 38% remained at or above 70P. At baseline, children in the seven groups differed in weight, ponderosity (wt/ht3), systolic and diastolic blood pressures, serum triglyceride levels, and pre-,/-and ,B-lipoprotein cholesterol levels. Pairwise comparison of data from children in each of the six other groups with those from children in the middle range (.40, <60P) showed that the obese and very obese children had significantly higher systolic blood pressures (p < .05), while only those in the highest P group had significantly greater diastolic blood pressures (p < .05). These differences increased and diverged over time. Those in the obese and very obese groups showed a striking drop over time in a-lipoprotein cholesterol levels and increases in pre-3-lipoprotein cholesterol levels and systolic blood pressure. Triglyceride levels decreased over time for the lowest and middle range groups but remained at higher levels in obese and very obese children. There was a strong tendency for tracking (remaining in the same P group over time) in lean, obese, and very obese children. Those who tracked showed definite differences in risk factor variables at the baseline level and over time when compared with the middle range group. Since consistent obesity in early life enhances cardiovascular risk, the measurement over time of skinfold thickness in children is a useful method to detect the potential for adult cardiovascular disease. Circulation 69, No. 5, 895-904, 1984. OBESITY is positively associated with cardiovascular risk factors such as hypertension, diabetes mellitus, and abnormal lipid and lipoprotein levels in adults. ' Although it has been related to other risk factor variables-9 in children, there is little information on effects of persistent obesity in early life. Because obesity can begin in childhood, it is important to determine the level at which it begins to influence cardiovascular risk. Individuals who have been obese from childhood tDeceased.Vol. 69, No. 5, May 1984 are of particular interest in the study of the early natural history of obesity and its relationship to the development of cardiovascular disease. Although no precise definition of obesity in a general population of children has been established, the tendency for a child to maintain over time the same relative rank in a dis...

The relationship of dietary K+ with Na+ balance in young normotensives was studied. A, In two biracial communities, all children with specified age were stratified by blood pressure level. Children from selected strata collected 24-h urines on ambulatory basis and provided fasting blood for electrolytes and creatinine determination. For the upper percentile ranks (n = 160), the Na+ and K+ clearances correlated closer in Blacks than whites (r = 0.7 versus r = 0.4, p less than 0.005 for difference). B, To test for a causal effect of K+ intake on Na+ excretion, six white and eight Black young healthy normotensive volunteers took 80 mEq KCl daily in addition to their usual diets. They collected 24-h ambulatory urine and stool samples for 3 base-line days, and 4 days during K+ supplementation. Na+ and K+ intake was monitored daily. Upon K+ supplementation, Blacks showed natriuresis (p less than 0.01), negative Na+ balance (p less than 0.05), and a cumulative K+ balance more positive than whites (p less than 0.0001 versus p less than 0.05). Dietary K+ enrichment could affect Na+ balance.

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Eleven patients with essential hypertension were treated with the beta adrenergic blocker, acebutolol. Clinical, systemic, and regional hemodynamic and biochemical studies were performed before and after 4 wk of acebutolol therapy (average doses, 1,200 mg/day.) In 4 patients there was a reduction in mean arterial pressure greater than or equal to 10 mm Hg; there was none in the remainder. Regardless of the blood pressure response, the renin secretory index did not change. Although cardiac output did not change, renal blood flow fell (p less than 0.005) without relation to response of arterial pressure. Supine heart rate decreased (p less than 0.05), so also the responses to upright tilt (p less than 0.01) and isometric exercise (p less than 0.02). These results demonstrate that in those patients with a hypotensive response to acebutolol, the clinical effect was not related to reduced cardiac output or plasma renin activity, further adding to confusion on the mechanism of the lowering of elevated blood pressure by beta adrenergic blockade.

SUMMARY The onset of essential hypertension early in life is indicated by the high tracking of blood pressure during adolescence; intervention in adults with mild hypertension has been found successful. How, then, can high blood pressure levels in children be modified to prevent early hypertensive cardiovascular disease in adulthood? In an entire biracial town (population 9000) we surveyed 1604 (89%) of all children aged 8-18 years for blood pressure and reexamined those in the upper decile of mean blood pressure (for each race, sex, and height) on three additional occasions. On each examination nine blood pressures were taken by trained observers. All children consistently in the top decile were randomly allocated into either a treatment (n = 50) or comparison (n = 50) group. These two groups and an additional midrange blood pressure comparison group (n = 50) were followed regularly using school facilities including community and school programs. Treatment consisted of 1) dietary guidance; 2) modifications of school lunches and snacks with healthy substitutes; 3) parental involvement; 4) a low dose diuretic and /3-antagonist given by usual standards. All study groups were monitored for blood pressure in a blind manner. In 6 months of observation, blood pressure in the treatment group remained 5 and 3 mm Hg (systolic and diastolic) less than controls (p < 0.001 and p < 0.01). An orchestrated community-wide attack on early-stage hypertension is feasible and seems to offer exciting potential for prevention of early hypertensive disease. (Hypertension 5: 41-53, 1983) KEY WORDS • blood pressure • hypertension in children • intervention • risk factors D URING the past 10 years there have been impressive developments in the understanding of the physiologic and biochemical mechanisms of essential hypertension and in its treatment. Significant progress has been made in the treatment of mild hypertension, in particular, and in the reduction of consequent cardiovascular and cerebrovascular disease. Most of this progress, however, has been obtained on adults at a time when organ damage has already occurred. During the past decade we have begun to investigate the early natural history of essential From the