Hemodynamic and Metabolic Profile in Offspring of Malignant Hypertensive Parents

Abstract

Abstract-Malignant hypertension is a serious form of arterial hypertension in which the physiopathological mechanisms include increased activity of the sympathetic nervous system, renin angiotensin system, and endothelium dysfunction. Family history of hypertension is an important predictive factor for hypertension and is associated with metabolic and hemodynamic abnormalities. Studies of these abnormalities in malignant hypertensive offspring have not yet been published. Therefore, we studied 42 offspring of malignant hypertensive parents (OMH group: age, 22Ϯ7 years; 23 male subjects; 27 white) and 35 offspring of normotensive parents (ONT group: age, 21Ϯ4 years; 23 male subjects; 25 white). All subjects had blood pressure Ͻ140/90 mm Hg. We evaluated body mass index; office blood pressure; 24-hour ambulatory and continuous beat-to-beat blood pressure monitoring (Finapres); biochemical analysis, including total cholesterol and fractions, triglycerides, glucose, and insulin; and hormonal analysis, including plasma renin activity, aldosterone, and catecholamines. The subjects were also submitted to cold pressure test and handgrip measurements. The body mass index was significantly higher in the OMH group (24Ϯ5 kg/m 2 ) than in the ONT group (22Ϯ4 kg/m 2 ). The OMH group showed significantly higher blood pressure and heart rate in office and Finapres measurements (PϽ0.05). In 24-hour ambulatory monitoring, the OMH group presented higher 24-hour blood pressure and heart rate, higher blood pressure during the night, and higher heart rate variability during the day compared with those of the ONT group. They also presented lower HDL cholesterol, higher levels of plasma insulin and norepinephrine, and higher insulin-to-glucose ratio (PϽ0.05) than the ONT group. There were no differences in the other biochemical parameters measured. In conclusion, OMH subjects show early hemodynamic, neurohumoral, and metabolic alterations that are typical of hypertensive metabolic syndrome.

Haemodynamic, metabolic and neuro-humoral abnormalities in young normotensive women at high familial risk for hypertension

“…Because of the small sample size, the higher low-density lipoprotein-cholesterol levels observed in FH þ þ group, as well as observed in the FH þ group (B18 mg 100 ml À1 ), cannot be dismissed because of the absence of statistical significance, and may have important clinical relevance. Higher low-density lipoprotein-cholesterol levels among normotensive offsprings of hypertensive parents compared with normotensive with normotensive parents have been shown by some investigators, 7,19,24,25,28 although negative finds exist. 18,26 Abnormalities in lipids, glucose and insulin metabolism have been found to be part of a complex of cardiovascular risk factors commonly found in hypertensive subjects.…”

“…The existence of early abnormalities of glucose and insulin metabolism among offsprings of hypertensive parents has been confirmed by some investigators, 7,19,[24][25][26] although not by all. 15,27 Previous studies have shown elevated fasting insulin and insulin-to- Early abnormalities in family hypertension EG Ciolac et al glucose levels, as well as reduced sensitivity of insulin-mediated cellular glucose disposal, in normotensive offspring of hypertensive parents; however, data have not been analysed separately by neither gender nor parental burden.…”

“…15,27 Previous studies have shown elevated fasting insulin and insulin-to- Early abnormalities in family hypertension EG Ciolac et al glucose levels, as well as reduced sensitivity of insulin-mediated cellular glucose disposal, in normotensive offspring of hypertensive parents; however, data have not been analysed separately by neither gender nor parental burden. 7,[24][25][26] The only study we have known that assayed fasting insulin and insulin resistance in normotensive with three different parental hypertension burden showed that normotensive offspring of two hypertensive parents had elevated plasma insulin levels and were more likely to show greater insulin resistance than normotensive individuals having either one hypertensive parent or normotensive parents; however, the data were also not analysed separately by gender. 19 This study demonstrated that insulin and insulin-toglucose ratio (a marker of insulin resistance) were higher in both women with two or one hypertensive parents than in women with normotensive parents, when a population of young normotensive women matched for age, menstrual cycle phase, BMI and BP levels were analysed.…”

“…4,5 Moreover, haemodynamic and metabolic abnormalities, as well as concentrations of biomarkers that may have a role in the development of hypertension are increased in nonhypertensive offspring of parents with hypertension. [6][7][8] Despite the large number of family history of hypertension researches, the underlying pathophysiology of family cluster hypertension is incompletely understood. Further, studies investigating the possible mechanisms involved in the pathophysiology of family history of hypertension have demonstrated contradictory findings.…”

“…11,12 Also, increased sympathetic activity in response to mental 13 or physical 14 stress has been shown in normotensive offspring of hypertensive parents, but there are contradictory findings relating to resting sympathetic activity. 7,[15][16][17][18][19] There are some issues regarding the methodology of family history of hypertension investigations that may explain these contradictory results. First, the subject's family history is not always verified by parents or doctors.…”