Relationship Between Adiponectin and Ambulatory Blood Pressure in Obese Adolescents

Shatat, Ibrahim F.; Freeman, Katherine; Vuguin, Patricia; DiMartino-Nardi, Joan; Flynn, Joseph T.

doi:10.1203/pdr.0b013e31819ea776

Cited by 47 publications

(28 citation statements)

References 31 publications

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“…In a recent study by Gilardini et al (26), nondipping patterns were found in 11% of obese children, and the loss of nocturnal BP fall correlated with sympathoadrenergic drive as indicated by catecholamine excretion and insulin resistance. In addition, Shatat et al (27) found that a significant number of obese children displayed nondipping phenomenon, and BP values were inversely correlated with adiponectin concentrations; however, they did not report any relation with dipping.…”

Section: Discussionmentioning

confidence: 95%

Altered Cardiovascular Rhythmicity in Children With White Coat and Ambulatory Hypertension

et al. 2010

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Adults with ambulatory hypertension or white coat hypertension (WCH) display abnormal cardiovascular rhythms. We studied cardiovascular rhythms by Fourier analysis of 24-h ambulatory blood pressure (BP) measurement profiles in 129 hypertensive children, 54 children with WCH, and 146 age-, height-, and gendermatched healthy subjects. The day/night mean arterial pressure ratio was lower in hypertensive and patients with WCH compared with controls (1.13 versus 1.16 versus 1.21, respectively; p Ͻ 0.0001). Eighty-five percent of controls were dippers compared with 74% of WCH (n.s.) and 64% of patients with ambulatory hypertension (p Ͻ 0.0001). The prevalence of 24-h rhythms was similar among the groups, but prevalence of 12-h BP rhythms was increased in hypertensive (67%) and WCH (72%) compared with controls (51%, p Ͻ 0.0001). The amplitudes of the 24-, 8-, and 6-h BP rhythms were reduced in hypertensive and WCH compared with controls (p Ͻ 0.05). Hypertensive and patients with WCH displayed delayed 24-, 12-, 8-, 6- S imilar to other functions of living organisms such as heart rate (HR), blood pressure (BP) also displays regular endogenous rhythmicity. Abnormalities of BP rhythms as assessed by analysis of ambulatory BP studies have been related to an increased risk of hypertensive target organ damage in adults (1-3).Although primary hypertension (PH) has its origins very early in childhood and adolescence, there are only scanty reports on BP rhythmicity in hypertensive children. There are no data comparing BP rhythmicity of healthy, normotensive children with hypertensive children and children with white coat hypertension (WCH). Moreover, it is still unclear whether WCH is only a benign form of enhanced reactivity not related to pathologic BP regulation or a true pathologic state related to disturbed BP rhythmicity, representing a prehypertension condition. Finally, because hypertension in adolescents is mainly linked with obesity, it is important to assess whether obesity has any independent impact on BP rhythmicity (4,5).We hypothesized that, similar to adults, children and adolescents with sustained ambulatory hypertension and WCH also have disturbed BP rhythms. To evaluate our hypothesis, we analyzed BP rhythmicity retrospectively in cohorts of untreated children with PH and WCH and compared the results with normative data obtained from healthy normotensive children (6). METHODS Patients.We included 183 children and adolescents referred to two tertiary centers (Children's Memorial Health Institute, Warsaw, Poland and Children's Hospital of Eastern Ontario, Ottawa, Canada) for further evaluation of hypertension based on an elevated office BP confirmed on at least three visits. All patients underwent the same diagnostic work up at both institutions. PH was diagnosed after a thorough clinical and laboratory diagnostic work up, according to recently published recommendations (7). Office BP values, measured with an oscillometric device (Dinamap 1846 SX; Criticon Inc., Tampa, FL) after at least 5 min of rest...

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Section: Discussionmentioning

confidence: 95%

Altered Cardiovascular Rhythmicity in Children With White Coat and Ambulatory Hypertension

et al. 2010

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“…The subjects underwent a 24-h ABP recording using the Spacelabs 90217 ambulatory monitor (Spacelabs Medical, Issaquah, WA), fitted, and programmed as previously described (7,12). Awake, or daytime, and sleep, or nocturnal, periods were determined by means of a diary provided by the subjects.…”

Section: Methodsmentioning

confidence: 99%

“…We have previously shown that adiponectin (an anti-inflammatory, anti-atherosclerotic adipokine) levels are inversely related to ambulatory blood pressure (ABP) (7), which is itself abnormal in obesity.…”

mentioning

confidence: 99%

Relationships Between Renin, Aldosterone, and 24-Hour Ambulatory Blood Pressure in Obese Adolescents

Shatat

Flynn

2011

Pediatr Res

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Renin-angiotensin system (RAS) activation and abnormalities of ambulatory blood pressure (ABP) are present in obesity, but relationships between components of the RAS and ABP have not been defined in the young. Anthropometric measurements and 24-h ABP were obtained on 30 obese adolescents with and without type 2 diabetes mellitus. Plasma renin activity (PRA), aldosterone, and other cardiovascular risk factors were measured. Median PRA levels were 2.5 [interquartile range (IQR), 1.7-4.1] ng/mL/h and were higher in the diabetic subjects compared with the nondiabetics. Females had significantly higher PRA than males 3.2 (IQR, 2-4.8) versus 1.8 (IQR, 1.1-2.9) ng/mL/h (p ϭ 0.04) and were more obese. BMI Z score and PRA were significantly correlated (rho ϭ 0.46, p Ͻ 0.001). PRA inversely correlated with 24-h systolic ABP (rho ϭ Ϫ0.46, p ϭ 0.02) and strongly with 24-h pulse pressure (rho ϭ Ϫ0.61, p ϭ 0.001). Aldosterone levels were also correlated with 24-h pulse pressure (rho ϭ Ϫ0.46, p ϭ 0.02). In multivariate models, lower PRA was independently associated with 24-h systolic blood pressure. In this study, PRA was positively correlated with BMI, but the relationships between components of the RAS and ABP were inverse. Further studies are needed to define the pathophysiologic relationship between RAS components and blood pressure regulation in obese youth. T he renin-angiotensin system (RAS) plays a central role in blood pressure (BP) regulation and fluid-electrolyte homeostasis, and its dysregulation contributes to the development of hypertension (1). Activation of the RAS in adipose tissue may represent an important link between obesity and hypertension. Studies have demonstrated that rat and human adipose tissue possess all of the components necessary for production of angiotensin II (Ang II), including angiotensinogen (2), renin-like activity (3), Ang-converting enzyme, and Ang type 1 receptor (4,5). Adipose-derived angiotensinogen is also released into the circulation where it serves as substrate for conversion to bioactive Ang II, contributes to plasma Ang II levels, and increases BP (6).Other metabolically active products of adipose tissue include adipokines. We have previously shown that adiponectin (an anti-inflammatory, anti-atherosclerotic adipokine) levels are inversely related to ambulatory blood pressure (ABP) (7), which is itself abnormal in obesity.Whether components of the RAS have similar relationships to ABP in obese youth is unknown. Our objective in this study was to examine the relationships between 24-h BP measurements and plasma renin activity (PRA) and aldosterone levels in obese adolescents. MATERIALS AND METHODSSetting and study design. Patients who fulfilled the following criteria were recruited from the Pediatric Diabetes and Pediatric Nephrology Clinics at the Children's Hospital at Montefiore in the Bronx, NY: age 10 to 21 y, obesity defined as BMI Ͼ95th percentile for age and gender (8), a diagnosis within the past 3 y of type 2 diabetes mellitus (T2DM) according to the standar...

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“…Elevated BP is common in obese adolescents, 305 and abnormalities of ambulatory BP are associated with abnormal metabolic factors. 306 In both the TODAY 172 and the SEARCH 68 studies, hypertension was common and was more frequent with increasing BMI. In another study using ambulatory BP monitoring, 307 abnormal BP patterns and microalbuminuria were both common in minority youth with relatively recently diagnosed T2DM.…”

Section: Type 2 Diabetes Mellitusmentioning

confidence: 99%

Cardiovascular Disease Risk Factors in Youth With Diabetes Mellitus

Maahs¹,

Daniels²,

Ferranti³

et al. 2014

Circulation

162

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Relationship Between Adiponectin and Ambulatory Blood Pressure in Obese Adolescents

Cited by 47 publications

References 31 publications

Altered Cardiovascular Rhythmicity in Children With White Coat and Ambulatory Hypertension

Altered Cardiovascular Rhythmicity in Children With White Coat and Ambulatory Hypertension

Relationships Between Renin, Aldosterone, and 24-Hour Ambulatory Blood Pressure in Obese Adolescents

Cardiovascular Disease Risk Factors in Youth With Diabetes Mellitus

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