The prevalence of primary hyperaldosteronism in the studied sample was 0.96% of the total. However, when only the patients with refractory hypertension were evaluated, the prevalence was 14.3%.

Risk factors act around birth increasing future vascular risk. In this study, we analysed the pathways from perinatal factors to the vascular risk phenotype (VRP) in adolescents including indirect pathways mediated by obesity in adolescence. Data from a Brazilian cohort were collected at birth and at 18 to 19 years (follow-up). A theoretical model was constructed to analyze the association between variables at birth (socioeconomic status, prepregnancy body mass index, mother’s age, history of maternal hypertension, maternal smoking, gestational age at birth, birth weight, sex, delivery type) and at follow-up (smoking and excess weight) with the VRP, using structural equation modeling. VRP was a continuous latent variable, representing the shared variance of blood pressure indictors and carotid-femoral pulse wave velocity. Males had higher VRP (standardized coefficient [SC], 0.561; P< 0.001). Higher prepregnancy body mass index was associated with higher VRP (SC, 0.140; P =0.032). Gestational age <34 weeks had a total (SC, 0.259; P =0.002) and direct effect (SC, 0.354; P =0.018) on VRP. Cesarean delivery had a total effect, albeit borderline, on VRP (SC, 0.159; P =0.066). Excess weight at follow-up was the main determinant of a high VRP (SC, 0.470; P< 0.001). Male sex, cesarean section, gestational age <34 weeks, pregestational excess weight, and excess weight in adolescents were associated with increased VRP at 18 to 19 years of age.

We hypothesize that early events of diabetes and cardiovascular disease continuums would be ongoing and associated in adolescents. We investigated the association between the Insulin Resistance Phenotype and the Vascular Risk Phenotype at the end of the second decade of life and indirect pathways from social vulnerability, alcohol consumption, and body fat mass. It is a population-based study in the RPS cohort of 18–19 years (n = 2,515), São Luís, Brazil. The theoretical model analyzed the association between Insulin Resistance Phenotype and Vascular Risk Phenotype by sex, using structural equation modeling (SEM). The Insulin Resistance Phenotype was a latent variable deduced from the correlations of Triglyceride to HDL ratio, Triglyceride Glycemic index, and VLDL; the Vascular Risk Phenotype was deduced from Systolic Blood Pressure, Diastolic Blood Pressure, and Pulse Wave Velocity. The Insulin Resistance Phenotype was directly associated with the Vascular Risk Phenotype in males (standardized coefficient SC = 0.183; p < 0.001) and females (SC = 0.152; p < 0.001). The Insulin Resistance Phenotype was an indirect pathway in the association of alcohol consumption and higher values of fat mass index with the Vascular Risk Phenotype. VLDL presented the highest factor loading, appearing as a marker of insulin resistance linked to cardiovascular risk in young people. Lower values of socioeconomic status, harmful use of alcohol, and high body fat values were also associated with higher values of the two phenotypes. The association of the Insulin Resistance Phenotype with the Vascular Risk Phenotype suggests common pathophysiological mechanisms present in early events in the continuums of diabetes and cardiovascular disease in adolescence.

Background: Endothelial dysfunction precedes structural abnormalities and atherosclerosis clinical manifestations, and thus it is considered an early marker of cardiovascular diseases. The objectives of this cross-sectional study were to determine the frequency of endothelial dysfunction in prehypertensive subjects and its association with demographic, anthropometric and clinical characteristics of the population studied. Methods and Results:Endothelial function was assessed by flowmediated vasodilation (FMD) of the brachial artery in 60 non-smoking and non-diabetic prehypertensive subjects aged 30-70 years who were recruited from the community. Variables analyzed were gender, age, race, sedentary lifestyle, dyslipidemia, body mass index, abdominal circumference and blood pressure. In order to evaluate the relationship between endothelial dysfunction and study variables, Student t, Mann-Whitney and chi-square tests were used. Multivariate logistic regression of variables analyzed with respect to endothelial dysfunction was applied in unadjusted as well as adjusted models (p<0.20). Significance level was set at 5%. Mean age of prehypertensive subjects was 42.6±9.2 years; 60% were females, 33.3% were Black, 61.6% were overweight, and 68.3% had a sedentary lifestyle. Endothelial dysfunction was detected in 36.7% of the population; its frequency was higher for Black subjects (45%). Association was established between endothelial dysfunction and males as well as obesity, the latter even after adjustment of the model (p=0.010). Conclusions:In conclusion, frequency of endothelial dysfunction as determined by FMD was high in the population under study, even IntroductionEndothelial dysfunction is associated with atherosclerosis progression and complications, and thus it is an early marker of cardiovascular disease (CVD). [1] Endothelial dysfunction as detected by flow-mediated vasodilation (FMD) of the brachial artery was related to the presence of coronary artery disease in 122 subjects undergoing coronary angiography, with 71% sensitivity and 81% specificity.[2] The positive predictive value of abnormal brachial dilation with respect to coronary endothelial dysfunction is 95%.[3] Therefore, assessment of endothelial function can help in the identification of early changes in asymptomatic subjects with CVD risk factors, such as prehypertension.Despite controversies over the use of the term 'prehypertension', studies have demonstrated that this clinical condition is an independent risk factor for the development of systemic arterial hypertension (SAH) and arteriosclerotic vascular disease. [4][5][6][7] Weil et al [8] have shown that, regardless of other CVD risk factors, prehypertension is associated with decreased blood flow in the forearm in response to acetylcholine infusion, suggesting less endotheliumdependent vasodilation. Moreover, it is known that increased age is associated to decreased endothelium-dependent vasodilation in humans and such reduction occurs earlier in males than females. [9,10] Neverthel...