RESUMO
Hypertension (HTN) in children and adolescents is an important pathology, of, guarded prognosis, associated with modifiable and non-modifiable factors. The estimated prevalence is around 3.5% which increases progressively with age. The ideal method for its diagnosis is the measurement of blood pressure (BP) with auscultatory instruments. According to the American Academy of Pedia trics (AAP), BP should be measured in children older than three years of age once a year, and in children younger than three years of age if they present risk factors. Once the HTN is confirmed, the evaluation should be directed towards the detection of a causative disease and/or the search for risk factors associated with a primary HTN. The objective of treating primary and secondary HTN in pediatrics is to achieve a BP level that decreases the risk of target organ damage. Therapeutic op tions include treatment according to specific etiology, non-pharmacological and pharmacological one. This paper presents the position of the Chilean Society of Pediatrics Nephrology Branch with the aim of guiding pediatricians and pediatric nephrologists in the correct management of HTN in childhood. In this second part, recommendations on antihypertensive treatment are presented with an emphasis on lifestyle changes.
Assuntos
Anti-Hipertensivos/administração & dosagem , Hipertensão/terapia , Estilo de Vida , Adolescente , Fatores Etários , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial , Criança , Pré-Escolar , Chile , Humanos , Hipertensão/diagnóstico , Guias de Prática Clínica como Assunto , Fatores de RiscoRESUMO
Resumen: La hipertensión arterial (HTA) en niños y adolescentes es una importante patología, de reservado pronóstico, asociada a factores modificables y no modificables. La prevalencia estimada es de apro ximadamente un 3,5%, la cual va aumentando progresivamente con la edad. El método ideal para su diagnóstico es la medición de la presión arterial (PA) con instrumentos auscultatorios. De acuerdo a la Academia Americana de Pediatría (AAP) la PA debe ser medida en niños mayores de 3 años una vez al año, y en niños menores de 3 años, si presentan factores de riesgo. Una vez confirmada la HTA, la evaluación debe dirigirse hacia la detección de una enfermedad causal y/o a la búsqueda de factores de riesgo asociados a una HTA primaria. El objetivo del tratamiento de la HTA primaria y secundaria en pediatría es lograr un nivel de PA que disminuya el riesgo de daño de los órganos blanco. Las opciones terapéuticas incluyen: tratamiento según etiología específica, no farmacológico y farmacológico. En esta Guia se presenta la posición de la Rama de Nefrología de la Sociedad Chile na de Pediatría con el objetivo de orientar a pediatras y nefrólogos infantiles en correcto manejo de la HTA en la infancia. En esta segunda parte se presentan las recomendaciones sobre el tratamiento antihipertensivo, haciendo énfasis en los cambios de estilo de vida.
Abstract: Hypertension (HTN) in children and adolescents is an important pathology, of, guarded prognosis, associated with modifiable and non-modifiable factors. The estimated prevalence is around 3.5% which increases progressively with age. The ideal method for its diagnosis is the measurement of blood pressure (BP) with auscultatory instruments. According to the American Academy of Pedia trics (AAP), BP should be measured in children older than three years of age once a year, and in children younger than three years of age if they present risk factors. Once the HTN is confirmed, the evaluation should be directed towards the detection of a causative disease and/or the search for risk factors associated with a primary HTN. The objective of treating primary and secondary HTN in pediatrics is to achieve a BP level that decreases the risk of target organ damage. Therapeutic op tions include treatment according to specific etiology, non-pharmacological and pharmacological one. This paper presents the position of the Chilean Society of Pediatrics Nephrology Branch with the aim of guiding pediatricians and pediatric nephrologists in the correct management of HTN in childhood. In this second part, recommendations on antihypertensive treatment are presented with an emphasis on lifestyle changes.
Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Hipertensão/terapia , Estilo de Vida , Anti-Hipertensivos/administração & dosagem , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial , Fatores de Risco , Fatores Etários , Guias de Prática Clínica como Assunto , Hipertensão/diagnósticoRESUMO
Hypertension (HT) in children and adolescents is an important pathology, associated with modi fiable and non-modifiable factors. In the pediatric, the prevalence of HT is around 3.5%, and it in creases progressively with age. The ideal method for diagnosis is the measurement of blood pressure (BP) with auscultatory instruments. As published by the American Academy of Pediatrics (AAP), BP should be measured in children over 3 years of age once a year, and in children under 3 years of age, if it presents risk factors. Once HT has been confirmed, the evaluation should be directed towards the detection of a causative disease and the search for risk factors associated with primary HTN. The goal of treating primary and secondary HTN in pediatrics is to achieve a level of BP that decreases the risk of target organ damage. The therapeutic options include: treatment according to specific etiology, non-pharmacological and pharmacological. This document is the product of a collaborative effort of the Nephrology Branch of the Chilean Society of Pediatrics with the aim of helping pediatricians and pediatric nephrologists in the diagnosis and treatment of hypertension in childhood. In this first part, the recommendations of the diagnosis and study are presented.
Assuntos
Hipertensão/diagnóstico , Hipertensão/terapia , Adolescente , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/métodos , Criança , Terapia Combinada , Humanos , Hipertensão/etiologia , Anamnese , Exame Físico , Fatores de RiscoRESUMO
Resumen: La hipertensión arterial (HTA) en niños y adolescentes es una patología importante, asociada a fac tores modificables y no modificables. En la edad pediátrica, la prevalencia de la HTA es de alrededor de un 3,5%, y va aumentando progresivamente con la edad. El método ideal para su diagnóstico es la medición de la presión arterial (PA) con instrumentos auscultatorios. Según lo publicado por la Academia Americana de Pediatría (AAP) la PA debe ser medida en niños mayores de 3 años una vez al año, y en niños menores de 3 años, si presenta factores de riesgo. Una vez confirmada la HTA, la evaluación debe dirigirse hacia la detección de una enfermedad causal y a la búsqueda de factores de riesgo asociados a una HTA primaria. El objetivo del tratamiento de la HTA primaria y secundaria en pediatría es lograr un nivel de PA que disminuya el riesgo de daño de órgano blanco. Las opcio nes terapéuticas incluyen: tratamiento según etiología específica, no farmacológico y farmacológico. Este documento es producto de un esfuerzo colaborativo de la Rama de Nefrología de la Sociedad Chilena de Pediatría con el objetivo de ayudar a los pediatras y nefrólogos infantiles en el diagnóstico y tratamiento de la HTA en la infancia. En esta primera parte, se presentan las recomendaciones del diagnóstico y estudio.
Abstract: Hypertension (HT) in children and adolescents is an important pathology, associated with modi fiable and non-modifiable factors. In the pediatric, the prevalence of HT is around 3.5%, and it in creases progressively with age. The ideal method for diagnosis is the measurement of blood pressure (BP) with auscultatory instruments. As published by the American Academy of Pediatrics (AAP), BP should be measured in children over 3 years of age once a year, and in children under 3 years of age, if it presents risk factors. Once HT has been confirmed, the evaluation should be directed towards the detection of a causative disease and the search for risk factors associated with primary HTN. The goal of treating primary and secondary HTN in pediatrics is to achieve a level of BP that decreases the risk of target organ damage. The therapeutic options include: treatment according to specific etiology, non-pharmacological and pharmacological. This document is the product of a collaborative effort of the Nephrology Branch of the Chilean Society of Pediatrics with the aim of helping pediatricians and pediatric nephrologists in the diagnosis and treatment of hypertension in childhood. In this first part, the recommendations of the diagnosis and study are presented.
Assuntos
Humanos , Criança , Adolescente , Hipertensão/diagnóstico , Hipertensão/terapia , Exame Físico , Determinação da Pressão Arterial/métodos , Fatores de Risco , Terapia Combinada , Hipertensão/etiologia , Anamnese , Anti-Hipertensivos/uso terapêuticoRESUMO
BACKGROUND: High sodium intake has been associated with various noncommunicable disease like hypertension, cardiovascular disease, or stroke. To estimate accurately sodium intake is challenging in clinical practice. We investigate the usefulness and limitations of assessing sodium intake simultaneously by dietary assessment and urinary samples in both children and adults. METHODS: We used a cross-sectional study design inviting 298 Chilean subjects (74 children and 222 adults) aged between 9 and 66 years of both genders. Sodium intake by dietary assessment was obtained from Chilean food composition data, based on FAO tables. Sodium and creatinine excretion were measured in 24-hour urine samples, in all participants. RESULTS: Adequate urinary collection was obtained in 81% of children (59/74) and 61% of adults (135/222). The mean sodium intake by dietary assessment was similar to the sodium excretion in 24 hours (3,121±1,153mg/d vs. 3,114±1,353mg/24h, P = nonsignificant) in children but was significantly lower (3,208±1,284mg/d vs. 4,160±1,651mg/24h, P < 0.001) in adults. In both children and adults, sodium intake correlated with urinary sodium excretion (r = 0.456, P < 0.003 and r = 0.390, P < 0.001, respectively). Secondary analyses also suggested that the dietary assessment was more inaccurate in overweight adult subjects. CONCLUSIONS: Our results showed that average sodium intake was higher than recommended in both children and adults (WHO ≤2,000mg/d). The sodium intake estimated by dietary assessment correlated with urinary excretion in all subjects, but in obese adults was more inaccurate than in children. Future studies to validate the appropriate test to assess sodium intake by age and nutritional status are warranted.
Assuntos
Inquéritos sobre Dietas , Sódio na Dieta/urina , Adolescente , Adulto , Idoso , Peso Corporal , Criança , Chile , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Adulto JovemRESUMO
BACKGROUND: The GTPase Rac1 has been implicated in hypertension as a modulator of mineralocorticoid receptor activity. Our aim is to investigate the frequency of polymorphisms rs10951982 (intron 1, G>A) and rs836478 (intron 3, T>C) in the RAC1 gene and perform association studies with clinical and biochemical parameters in a Chilean pediatric cohort. METHODS: Two hundred two normotensive (NT) subjects (aged 4-16 years) were divided into 2 groups: NT subjects with hypertensive parents (NH; n = 103) and NT subjects with NT parents (NN; n = 99). We measured markers of inflammation (high-sensitivity C-reactive protein, interleukin 6 (IL-6), interleukin 8, and tumor necrosis factor α), endothelial damage (Plasminogen activator inhibitor-1 metalloproteinase-9, and metalloproteinase-2), and oxidative stress (malondialdehyde). Data were expressed as median and interquartile range (IQR). RESULTS: We found differences in polymorphism rs836478 (intron 3, C>T) in both genotypic (χ(2) = 15.2, 2 df; P = 0.0005) and allelic (X(2)=5.5, 1 df; P = 0.01) frequencies in NH vs. NN subjects. NH subjects with a TT genotype showed increase MMP9 expression (median = 2.3, IQR - 1.6-3.2; vs. median = 1.6, IQR = 1.6-2.3 AU; P = 0.01) and lower IL-6 expression (median = 8.8, IQR = 7.0-11.8; vs. median = 12.1, IQR = 8.2-14.7 pg/ml; P = 0.02) compared with subjects with TC/CC genotype. No difference in the allelic frequency distribution was seen in the polymorphism rs10951982 (NH vs. NN: χ(2)=0.2, 1 df; P = 0.6). For this SNP, NN subjects with GA/AA genotype showed decreased diastolic BP indexes compared with subjects with native GG genotype (median = 1.08, IQR = 1.0-1.2; vs. median = 0.99, IQR = 0.94-1.1; P = 0.02). CONCLUSIONS: We report the frequency of polymorphisms rs836478 and rs10951982 of the RAC1 gene in a Spanish-Amerindian cohort. The polymorphism rs836478 was associated with an increased expression in markers of inflammation and endothelial damage (MMP9 and IL-6) in pediatric subjects with a hypertensive genetic background.
Assuntos
Pressão Sanguínea/genética , Hipertensão/genética , Polimorfismo de Nucleotídeo Único , Proteínas rac1 de Ligação ao GTP/genética , Adolescente , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Chile/epidemiologia , Estudos Transversais , Progressão da Doença , Feminino , Frequência do Gene , Predisposição Genética para Doença , Humanos , Hipertensão/sangue , Hipertensão/enzimologia , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Mediadores da Inflamação/sangue , Íntrons , Masculino , Razão de Chances , Linhagem , Fenótipo , Medição de Risco , Fatores de RiscoRESUMO
BACKGROUND: Impairment in 11ß-hydroxysteroid dehydrogenase type 2 (11ß-HSD2) activity results in inefficient inactivation of cortisol to cortisone, and it can trigger hypertension through activation of the mineralocorticoid receptor. Information about age-related changes in 11ß-HSD2 activity and its physiological consequences is scarce. Our aim was to investigate whether 11ß-HSD2 activity is age dependent in normotensive subjects. METHODS: We recruited 196 healthy, normotensive subjects. Of these, 93 were children (Group 1: aged 5-15 years), and 103 were adults who were divided according to their ages: Group 2: aged 30-41 years (n = 10); Group 3: aged 42-53 years (n = 72); and Group 4: aged 54-65 years (n = 21). Fasting serum cortisol, cortisone, aldosterone, and plasma renin activity (PRA) were measured. The 11ß-HSD2 activity was estimated by the cortisol/cortisone ratio. The results were expressed as median (interquartile range (IQR)) values and compared using Kruskal-Wallis and Dunn's multiple-comparison tests. RESULTS: As subject age increased, cortisol concentrations increased (Group 1 median = 8.6, IQR = 6.3-10.8 µg/dl; Group 4 median = 12.4, IQR = 10.7-14.7 µg/dl; P < 0.001), and cortisone concentrations showed a gradual decrease (Group 2 median = 4.0, IQR = 3.3-4.2 µg/dl; Group 4 median =2.8, IQR = 2.6-3.3 µg/dl; P < 0.01). As a consequence, the cortisol/cortisone ratio was higher in the oldest subjects (Group 4) than in the subjects from the other 3 groups; the ratios from Group 4 to Group 1 were 4.4 (IQR = 3.7-5.1) µg/dl, 3.3 (IQR = 2.7-3.8) µg/dl, 2.5 (IQR = 2.3-3.8) µg/dl, and 2.7 (IQR = 2.1-3.4) µg/dl, respectively (P < 0.01). The PRA decreased with age. Blood pressure levels increased with age but stayed within the normal range. CONCLUSIONS: Cortisol and the cortisol/cortisone ratio increased with age, but cortisone decreased, suggesting a decrease in 11ß-HSD2 activity. These results suggest that the cortisol-mediated activation of the mineralocorticoid receptor may explain the blood pressure increase in elderly subjects.
Assuntos
11-beta-Hidroxiesteroide Desidrogenase Tipo 2/metabolismo , Envelhecimento/fisiologia , Pressão Sanguínea/fisiologia , Hipertensão/enzimologia , Adolescente , Adulto , Criança , Cortisona/sangue , Estudos Transversais , Feminino , Humanos , Hidrocortisona/sangue , Masculino , Pessoa de Meia-Idade , Renina/sangueRESUMO
INTRODUCTION: From an early age, hypertension can damage blood vessels through multiple mechanisms. The aim of this study was to evaluate the presence of vascular damage and whether it is associated with the mineralo- and glucocorticoid profiles of hypertensive children. SUBJECTS AND METHODS: We studied 64 hypertensive children. Anthropometric parameters and serum aldosterone (SA), plasma renin activity (PRA), aldosterone/renin ratio (ARR), cortisol (F) and cortisone (E) were measured. The serum F/E ratio was calculated to estimate the activity of the enzyme 11ß-HSD2. Vascular damage was determined by carotid intima-media thickness (cIMT) and flow-mediated dilation of the brachial artery (FMD) on ultrasound. RESULTS: (median; Q1-Q3) Of the patients observed, 39% were females, and the median value for age (years) was 11.2 (9.1-13.3), for BMI (SDS) was 1.36 (0.84-1.80), for body fat mass (%) was 28.3 (17.8-36.0), for SBP index was 1.17 (1.12-1.25) and for the DBP index was 1.27 (1.16-1.36). Measurements revealed an SA level higher than 491 pmol/l in 4/64 patients, a PRA value lower than 0.5 ng/ml/h in 2/64, an ARR higher than 10 in 3/64 and serum F/E ratio higher than 4.3 in 10/64. The median brachial FMD (%) was 8.41 (5.61-10.91), and the median cIMT (mm) was 0.40 (0.37-0.43). The ARR was the only variable that explained changes in cIMT (ß = 0.571, R(2 ) = 0.315, P < 0.0001). CONCLUSION: Our results showed a positive association between cIMT and the ARR, suggesting an important role of the renin-aldosterone axis in the regulation of early vascular damage in hypertensive children.
Assuntos
Aldosterona/sangue , Espessura Intima-Media Carotídea , Hipertensão/sangue , Renina/sangue , Adolescente , Criança , Feminino , Humanos , MasculinoRESUMO
CONTEXT: Low birth weight has been independently associated with adult hypertension, and renin-angiotensin system (RAS) plays a role in this connection. OBJECTIVE: To characterize the associations between birth weight (BW) and serum aldosterone (SA), serum cortisol, plasma renin activity (PRA) and blood pressure (BP). DESIGN: Cross-sectional study. SUBJECTS: Children from the community born at a gestational age >32 weeks. METHODS: Systolic and diastolic BP indices (SBPi and DBPi) were calculated using the observed BP/50th percentile BP for gender, age and stature. BW was transformed to a standard deviation score (SDS) for gestational age, whereas SA, serum cortisol and PRA were transformed using the natural log. RESULTS: We selected 288 subjects between the ages of 4·9 and 15·5 years (Females, 50%). After adjusting for body mass index (BMI) SDS and Tanner, multiple regression analysis revealed that BW (SDS) was both independently and inversely associated with the natural log of SA (ß = -0·065; P = 0·039), the natural log of serum cortisol (ß = -0·064; P = 0·009), SBPi (ß = -0·012; P = 0·020) and DBPi (ß = -0·023; P = 0·002). An association was not observed with PRA (P = 0·178) and aldosterone renin ratio (ARR) (P = 0·452). Serum cortisol levels were positively associated with SA (r = 0·125; P = 0·034), while an association with PRA (P = 0·251) and ARR (P = 0·052) was not observed. CONCLUSIONS: The results of this study demonstrate an inverse association between birth weight and blood pressure and serum aldosterone and cortisol levels. This association is independent of BMI and Tanner, suggesting foetal programming of the hypothalamic-pituitary-adrenal axis.
Assuntos
Aldosterona/sangue , Peso ao Nascer/fisiologia , Pressão Sanguínea/fisiologia , Hidrocortisona/sangue , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Modelos Lineares , MasculinoRESUMO
Familial hyperaldosteronism type I is caused by an unequal crossover of 11ß-hydroxylase (CYP11B1) and aldosterone synthase (CYP11B2) genes, giving rise to a chimeric CYP11B1/CYP11B2 gene (CG). We describe a family carrying a CG with high levels of free 18-hydroxycortisol but low prevalence of primary aldosteronism (PA) and an atypical CG inheritance pattern in a family of 4 generations with 16 adults and 13 children, we measured the arterial blood pressure, serum aldosterone, and plasma renin activity and then calculated the serum aldosterone:plasma renin activity ratio and urinary free 18-hydroxycortisol. We identified the CG by long-extension PCR and predicted its inheritance pattern. The CG was found in 24 of 29 subjects (10 children and 14 adults). In CG+ patients, hypertension and high 18-hydroxycortisol were prevalent (83% and 100%, respectively). High serum aldosterone:plasma renin activity ratio was more frequent in pediatric than adult patients (80% versus 36%; P<0.001). An inverse association between serum aldosterone:plasma renin activity ratio and age was observed (r=-0.48; P=0.018). Sequence analysis identified the CYP11B1/CYP11B2 crossover in a 50-bp region spanning intron 3 of CYP11B1 and exon 4 of CYP11B2. The CG segregation differs from an autosomal disease, showing 100% of CG penetrance in generations II and III. Statistical analysis suggests that inheritance pattern was not attributed to random segregation (P<0.001). In conclusion, we describe a family with an atypical CYP11B1/CYP11B2 gene inheritance pattern and variable phenotypic expression, where the majority of pediatric patients have primary aldosteronism. Most adults have normal aldosterone and renin levels, which could mask them as essential hypertensives.
Assuntos
Segregação de Cromossomos/genética , Citocromo P-450 CYP11B2/genética , Hiperaldosteronismo/epidemiologia , Hiperaldosteronismo/genética , Esteroide 11-beta-Hidroxilase/genética , Adolescente , Adulto , Aldosterona/sangue , Chile/epidemiologia , Pontos de Quebra do Cromossomo , Saúde da Família , Feminino , Humanos , Hiperaldosteronismo/sangue , Masculino , Proteínas Mutantes Quiméricas/genética , Linhagem , PrevalênciaRESUMO
BACKGROUND: Hypertension in children is a frequently overlooked problem that is an important cardiovascular risk factor. AIM: To determine the prevalence of hypertension among school age children. MATERIAL AND METHODS: Cross-sectional study of 2980 children aged 10 ± 2 years (48% females) from 10 schools of middle and lower class in Metropolitan Santiago. Blood pressure (BP) was measured in the sitting position on three occasions after a rest period, using a mercury sphygmomanometer with appropriate cuff arm diameter, averaging the results of the measurements. Systolic and diastolic hypertension were defined as blood pressure values over 95 percentile for age, sex and height. RESULTS: The overall prevalence of hypertension was 12.2% in women and 15% in men (p < 0.05). According to nutritional status, the prevalence was 6.7, 8.9,13.6 and 26% in underweight, eutrophic, overweight and obese children, respectively (p < 0.01). Compared with normal weight children, the risk of being hypertensive for overweight children was 1.6 (95% confidence intervals (CI) 1.2-2.3) and for obese children was 3.6 (95% CI 2.8-4.7). CONCLUSIONS: The studied children had a high prevalence of hypertension, that was directly related to a higher body mass index.
Assuntos
Hipertensão/epidemiologia , Obesidade/epidemiologia , Adolescente , Distribuição por Idade , Índice de Massa Corporal , Criança , Chile/epidemiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/etiologia , Masculino , Estado Nutricional , Obesidade/complicações , Prevalência , Fatores de Risco , Fatores SocioeconômicosRESUMO
Background: Hypertension in children is a frequently overlooked problem that is an important cardiovascular risk factor. Aim: To determine the prevalence of hypertension among school age children. Material and Methods: Cross-sectional study of 2980 children aged 10 ± 2years (48 percent females) from 10 schools of middle and lower class in Metropolitan Santiago. Blood pressure (BP) was measured in the sitting position on three occasions after a rest period, using a mercury sphygmomanometer with appropriate cuff arm diameter, averaging the results of the measurements. Systolic and diastolic hypertension were defined as blood pressure values over 95percentilefor age, sex and height. Results: The overall prevalence of hypertension was 12.2 percent in women and 15 percent in men (p < 0.05). According to nutritional status, the prevalence was 6.7, 8.9,13.6 and 26 percent in underweight, eutrophic, overweight and obese children, respectively (p < 0.01). Compared with normal weight children, the risk of being hypertensive for overweight children was 1.6 (95 percent confidence intervals (CI) 1.2-2.3) and for obese children was 3.6 (95 percent CI 2.8-4.7). Conclusions: The studied children had a high prevalence of hypertension, that was directly related to a higher body mass index.
Assuntos
Adolescente , Criança , Feminino , Humanos , Masculino , Hipertensão/epidemiologia , Obesidade/epidemiologia , Distribuição por Idade , Índice de Massa Corporal , Chile/epidemiologia , Estudos Transversais , Hipertensão/etiologia , Estado Nutricional , Obesidade/complicações , Prevalência , Fatores de Risco , Fatores SocioeconômicosRESUMO
Familial hyperaldosteronism type 1 is an autosomal dominant disorder attributed to a chimeric CYP11B1/CYP11B2 gene (CG). Its prevalence and manifestation in the pediatric population has not been established. We aimed to investigate the prevalence of familial hyperaldosteronism type 1 in Chilean hypertensive children and to describe their clinical and biochemical characteristics. We studied 130 untreated hypertensive children (4 to 16 years old). Blood samples for measuring plasma potassium, serum aldosterone, plasma renin activity, aldosterone/renin ratio, and DNA were collected. The detection of CG was performed using long-extension PCR. We found 4 (3.08%) of 130 children with CG who belonged to 4 unrelated families. The 4 patients with CG had very high aldosterone/renin ratio (49 to 242). In addition, we found 4 children and 5 adults who were affected among 21 first-degree relatives. Of the 8 affected children, 6 presented severe hypertension, 1 presented prehypertension, and 1 presented normotension. High serum aldosterone levels (>17.7 ng/dL) were detected in 6 of 8 subjects (range: 18.6 to 48.4 ng/dL) and suppressed plasma renin activity (≤0.5 ng/mL per hour) and high aldosterone/renin ratio (>10) in 8 of 8 children (range: 49 to 242). Hypokalemia was observed in only 1 of 8 children. We demonstrated that the prevalence of familial hyperaldosteronism type 1 in a pediatric hypertensive pediatric population was surprisingly high. We found a high variability in the clinical and biochemical characteristics of the affected patients, which suggests that familial hyperaldosteronism type 1 is a heterogeneous disease with a wide spectrum of presentations even within the same family group.
Assuntos
Pressão Sanguínea/fisiologia , Hiperaldosteronismo/genética , Hipertensão/fisiopatologia , Adolescente , Adulto , Aldosterona/sangue , Criança , Pré-Escolar , Chile/epidemiologia , Comorbidade , Estudos Transversais , Citocromo P-450 CYP11B2/genética , Saúde da Família , Fusão Gênica/genética , Humanos , Hiperaldosteronismo/epidemiologia , Hiperaldosteronismo/patologia , Hipertensão/sangue , Hipertensão/epidemiologia , Reação em Cadeia da Polimerase , Potássio/sangue , Prevalência , Renina/sangue , Esteroide 11-beta-Hidroxilase/genéticaRESUMO
Background: Waist to height ratio and ultrasensitive C-reactive protein are predictors of the presence of the metabolic syndrome in children. Aim: To determine the proportional risk of metabolic syndrome component clustering in children, using waist to height ratio and ultrasensitive C-reactive protein. Material and Methods: Anthropometric measures, blood pressure, fasting serum lipid profle, blood glucose and ultrasensitive C-reactive protein were determined in 209 children aged 11.5 ± 2 years (50 percent females). The presence of the metabolic syndrome as a function of waist to height ratio and C-reactive protein was modeled using logistic regression equations. The risk of clustering one, two or more components of the metabolic syndrome was calculated. Results: Metabolic syndrome was present in 5 percent of all children and 18 percent of those that were obese. The cut off points for waist to hip ratio and ultrasensitive C-reactive protein were 0.55 and 0.61 mg/L, respectively. For each 0.01 increment in waist to height ratio, the odds ratio of increasing one component of the metabolic syndrome was 1.2 (1.15-1.25) or 15 to 25 percent. The odds ratio for log-transformed ultrasensitive C-reactive protein was 1.62 (1.26-2.09). Excluding waist circumference, the odds ratio of adding one or more components of the metabolic syndrome was 1.05 (1.01-1.09) per 0.01 increment in waist to height ratio, but the odds ratio for C-reactive protein was no longer significant. Conclusions: Waist to height ratio and ultrasensitive C-reactive protein predict the risk of clustering components of the metabolic syndrome in these children.
Assuntos
Criança , Feminino , Humanos , Masculino , Proteína C-Reativa/análise , Síndrome Metabólica/diagnóstico , Circunferência da Cintura/fisiologia , Antropometria , Biomarcadores/sangue , Métodos Epidemiológicos , Síndrome Metabólica/epidemiologia , Valores de ReferênciaRESUMO
Background: A cardiovascular risk score for children, that includes traditional risk factors, obesity, sedentary habits and a family history of cardiovascular disease, has been recently proposed by Spanish researchers. Aim: To apply this score in school age children in Santiago de Chile and correlate its results with markers of subclinical atherosclerotic disease. Material and Methods: Retrospective analysis of data obtained from 209 children, aged 11.5 ± 2 years, studied between 2005 and 2006. Weight, height, blood pressure, ultrasound measurement of carotid intimamedia thickness and fow mediated dilatation of brachial artery and ultrasensible C reactive protein (us PCR) were measured. The Spanish cardiovascular risk score was calculated and correlated with ultrasound parameters and C reactive protein. Results: According to the score, 173 children (83 percent) had a low cardiovascular risk, 28 (13 percent) an intermediate risk and 8 (4 percent) a high risk. There was no association between the cardiovascular risk score and carotid intima-media thickness, fow mediated arterial dilatation and us PCR. Conclusions: No significant association was observed between the proposed cardiovascular risk score and early markers of atherosclerotic disease in this group of children.
Assuntos
Adolescente , Criança , Feminino , Humanos , Masculino , Aterosclerose/epidemiologia , Proteína C-Reativa/análise , Aterosclerose/etiologia , Aterosclerose , Biomarcadores/análise , Artérias Carótidas , Chile , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Túnica ÍntimaRESUMO
Primary aldosteronism is an important cause of secondary hypertension and is suspected in adults with an aldosterone/renin ratio > or =25. The normal aldosterone/renin ratio is unknown in children. The aim was to establish serum aldosterone, plasma renin activity, and aldosterone/renin ratio values in a healthy pediatric population. A cross-sectional study was performed in 211 healthy normotensive children (4 to 16 years old). Two subgroups of normotensive children were obtained: with hypertensive parents (NH) (n=113) and normotensive parents (n=98). Blood samples for measuring serum aldosterone, plasma renin activity, aldosterone/renin ratio, and DNA were collected. In subjects with aldosterone/renin ratio > or =25, the chimeric CYP11B1/CYP11B2 gene was investigated by long-extension PCR. Results are expressed as median [Q(1)-Q(3)]. NH and normotensive parents groups were similar in serum aldosterone (6.5 [3.6 to 9.0] ng/dL versus 6.5 [2.9 to 9.7] ng/dL; P=0.968) and plasma renin activity (2.3 [1.6 to 3.1] versus 2.4 [1.7 to 3.7] ng/mL per hour; P=0.129). The aldosterone/renin ratio was higher in the NH group, but this difference did not reach statistical significance (2.8 [1.9 to 4.1] versus 2.5 [1.4 to 4.0], P=0.104). In one subject of the NH group, the chimeric CYP11B1/CYP11B2 gene was detected. We demonstrated that normal aldosterone/renin ratio values in a healthy pediatric population without NH were lower than those reported for an adult normotensive population.
Assuntos
Aldosterona/sangue , Renina/sangue , Adolescente , Pressão Sanguínea/fisiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Reação em Cadeia da Polimerase , Radioimunoensaio , Estatísticas não Paramétricas , Esteroide 11-beta-Hidroxilase/genéticaRESUMO
Aldosterone plays an important role in blood pressure homeostasis, the regulation of circulating volume, and the maintenance of the sodium-potassium balance by binding to the mineralocorticoid receptor (MR). Primary aldosteronism (PA) states are associated with an increased cardiovascular risk, mediated not only by hypertension but also by the action of aldosterone in the modulation of vasodilation/vasoconstriction and oxidative stress. In this review, we discuss some of the cardiovascular actions of aldosterone and the most frequent causes of PA.
Assuntos
Endotélio Vascular/fisiopatologia , Hiperaldosteronismo/fisiopatologia , Hipertensão/etiologia , Estresse Oxidativo , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/complicações , Hipertensão/sangue , Hipertensão/fisiopatologiaRESUMO
BACKGROUND: Low levels of adiponectin have been associated with metabolic risk factors (RF) and cardiac disease. Minimal data is available about the relationship between adiponectin and subclinical atherosclerosis. OBJECTIVES: To determine the relationship of adiponectin to cardiometabolic RF, C-reactive protein (CRP), anthropometric parameters of obesity, and subclinical atherosclerosis in children. METHODS: Cross-sectional study in 103 children. We determined body mass index (BMI), waist circumference, percent fat mass, systolic and diastolic blood pressures, fasting lipid profile, glycemia and insulinemia, and CRP. Subclinical atherosclerosis was determined by carotid intima-media thickness (IMT) and flow-mediated dilation of the brachial artery (FMD). RESULTS: Mean age of the group was 12.4+/-1.9 years (47% girls; 20.4% prepubertal; 45 eutrophic, 23 overweight and 35 obese). Adiponectin levels were not statistically significantly different in eutrophic children versus obese+overweight: 17.7+/-5.6 and 15.9+/-5.3 microg/mL, respectively. Adiponectin levels in boys were no different from those in girls. Adiponectin correlated significantly with age, BMI, zBMI, waist circumference, systolic and diastolic blood pressures, HDL, insulinemia, and HOMA index. No statistically significant association with adiponectin was found for CRP, FMD or IMT. After adjusting by sex, pubertal status, and degree of obesity, the adiponectin levels associated significantly with HDL cholesterol and the HOMA index (r(2)=0.34, p<0.0001). CONCLUSIONS: Adiponectin levels were inversely correlated with anthropometric parameters of obesity and insulin resistance and directly correlated with HDL levels. However, no relationship with subclinical atherosclerosis was demonstrated in this study.
Assuntos
Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/epidemiologia , Adiponectina/sangue , Adolescente , Glicemia/metabolismo , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Doenças das Artérias Carótidas/diagnóstico por imagem , Criança , HDL-Colesterol/sangue , Estudos Transversais , Feminino , Humanos , Insulina/sangue , Lipídeos/sangue , Masculino , Obesidade/sangue , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Ultrassonografia , Circunferência da CinturaRESUMO
BACKGROUND: Waist to height ratio and ultrasensitive C-reactive protein are predictors of the presence of the metabolic syndrome in children. AIM: To determine the proportional risk of metabolic syndrome component clustering in children, using waist to height ratio and ultrasensitive C-reactive protein. MATERIAL AND METHODS: Anthropometric measures, blood pressure, fasting serum lipid profile, blood glucose and ultrasensitive C-reactive protein were determined in 209 children aged 11.5 ± 2 years (50% females). The presence of the metabolic syndrome as a function of waist to height ratio and C-reactive protein was modeled using logistic regression equations. The risk of clustering one, two or more components of the metabolic syndrome was calculated. RESULTS: Metabolic syndrome was present in 5% of all children and 18% of those that were obese. The cut off points for waist to hip ratio and ultrasensitive C-reactive protein were 0.55 and 0.61 mg/L, respectively. For each 0.01 increment in waist to height ratio, the odds ratio of increasing one component of the metabolic syndrome was 1.2 (1.15-1.25) or 15 to 25%. The odds ratio for log-transformed ultrasensitive C-reactive protein was 1.62 (1.26-2.09). Excluding waist circumference, the odds ratio of adding one or more components of the metabolic syndrome was 1.05 (1.01-1.09) per 0.01 increment in waist to height ratio, but the odds ratio for C-reactive protein was no longer significant. CONCLUSIONS: Waist to height ratio and ultrasensitive C-reactive protein predict the risk of clustering components of the metabolic syndrome in these children.
Assuntos
Proteína C-Reativa/análise , Síndrome Metabólica/diagnóstico , Circunferência da Cintura/fisiologia , Antropometria , Biomarcadores/sangue , Criança , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Valores de ReferênciaRESUMO
BACKGROUND: A cardiovascular risk score for children, that includes traditional risk factors, obesity, sedentary habits and a family history of cardiovascular disease, has been recently proposed by Spanish researchers. AIM: To apply this score in school age children in Santiago de Chile and correlate its results with markers of subclinical atherosclerotic disease. MATERIAL AND METHODS: Retrospective analysis of data obtained from 209 children, aged 11.5 ± 2 years, studied between 2005 and 2006. Weight, height, blood pressure, ultrasound measurement of carotid intimamedia thickness and fow mediated dilatation of brachial artery and ultrasensible C reactive protein (us PCR) were measured. The Spanish cardiovascular risk score was calculated and correlated with ultrasound parameters and C reactive protein. RESULTS: According to the score, 173 children (83%) had a low cardiovascular risk, 28 (13%) an intermediate risk and 8 (4%) a high risk. There was no association between the cardiovascular risk score and carotid intima-media thickness, fow mediated arterial dilatation and us PCR. CONCLUSIONS: No significant association was observed between the proposed cardiovascular risk score and early markers of atherosclerotic disease in this group of children.