Children and adolescents (n=3906, 10-15 years old) have been participating in a screening program for high blood pressure. Sixty-four individuals (17-23 years old) from this population were followed up for 8 years and four consecutive screenings and were stratified into three groups according to blood pressure: group 1 (n=23), > or = 95th percentile for at least three of four evaluations; group 2 (n=28), < 50th percentile for at least three of four screenings; and group 3 (n=13), with unstable blood pressure percentiles. All 64 individuals underwent an oral glucose tolerance test after a 12-hour fast. Blood samples were collected at 0, 30, 60, 90, and 120 minutes for insulin and glucose measurements. Group 1 had a greater body mass index and higher systolic and diastolic blood pressures, basal glucose and insulin levels, and peak values of insulin and glucose levels than the other groups (P<.05). Group 1 also had a higher prevalence of overweight and abnormal values of basal insulin than the other groups (P<.05) and a higher proportion of glucose-intolerant individuals when compared with group 2 (P<.05). Systolic and diastolic blood pressures were positively related to body mass index (P<.05) and insulin variables (P<.05); however, when body mass index was controlled for, only systolic blood pressure demonstrated a significant correlation with insulin variables (P<.05). The association of overweight, hyperinsulinemia, glucose intolerance, and high blood pressure can be detected early, but the significance of these findings would be better explained by longitudinal studies.
BP level in children and adolescents was a good marker for familial aggregation of metabolic RF, suggesting an interaction of genetic and environmental factors. Primary intervention should be carried out in early stages of life.
BackgroundThe role of angiotensin-converting enzyme genetic polymorphisms as a predictor of
echocardiographic outcomes on heart failure is yet to be established. The local
profile should be identified so that the impact of those genotypes on the
Brazilian population could be identified. This is the first study on exclusively
non-ischemic heart failure over a follow-up longer than 5 years. ObjectiveTo determine the distribution of angiotensin-converting enzyme genetic
polymorphism variants and their relation with echocardiographic outcome of
patients with non-ischemic heart failure. MethodsSecondary analysis of the medical records of 111 patients and identification of
the angiotensin-converting enzyme genetic polymorphism variants, classified as DD
(Deletion/Deletion), DI (Deletion/Insertion) or II (Insertion/Insertion). ResultsThe cohort means were as follows: follow-up, 64.9 months; age, 59.5 years; male
sex, 60.4%; white skin color, 51.4%; use of beta-blockers, 98.2%; and use of
angiotensin-converting-enzyme inhibitors or angiotensin receptor blocker, 89.2%.
The angiotensin-converting enzyme genetic polymorphism distribution was as
follows: DD, 51.4%; DI, 44.1%; and II, 4.5%. No difference regarding the clinical
characteristics or treatment was observed between the groups. The final left
ventricular systolic diameter was the only isolated echocardiographic variable
that significantly differed between the angiotensin-converting enzyme genetic
polymorphisms: 59.2 ± 1.8 for DD versus 52.3 ± 1.9 for DI versus 59.2 ± 5.2 for II
(p = 0.029). Considering the evolutionary behavior, all echocardiographic
variables (difference between the left ventricular ejection fraction at the last
and first consultation; difference between the left ventricular systolic diameter
at the last and first consultation; and difference between the left ventricular
diastolic diameter at the last and first consultation) differed between the
genotypes (p = 0.024; p = 0.002; and p = 0.021, respectively). ConclusionThe distribution of the angiotensin-converting enzyme genetic polymorphisms
differed from that of other studies with a very small number of II. The DD
genotype was independently associated with worse echocardiographic outcome, while
the DI genotype, with the best echocardiographic profile (increased left
ventricular ejection fraction and decreased left ventricular diameters).
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