Abstract
We investigated in a young Italian obese population, the relationship between ambulatory BP (ABP) and several pathophysiological factors linking obesity to hypertension. A total of 89 obese children and adolescents underwent a 24-h ambulatory BP monitoring (ABPM) and an oral glucose tolerance test. The circulating levels of insulin, lipids, uric acid, C-reactive protein, interleukin-6, renin and aldosterone and the 24-h urinary levels of epinephrine, norepinephrine and albumin excretion rate were measured. Nine percent of subjects had daytime sustained hypertension (SH), 26 % night-time hypertension and 11 % a non-dipping pattern. SH subjects compared to those with sustained normotension (SN) were more obese (P<0.05), with a more frequent family history of hypertension (P<0.05), higher urinary catecholamine (P<0.05) and heart rate values (P<0.05) after adjustment for standard deviation score (SDS) of body mass index (BMI) and sex. Subjects with night-time hypertension compared to those with night-time normotension were more obese (P<0.0001), with a higher prevalence of impaired glucose tolerance (P<0.05) and metabolic syndrome (P<0.05) and higher 2-h glucose (P<0.05), uric acid (P<0.05) and triglycerides (P<0.05). In multivariate regression analysis, daytime systolic BP (SBP) remained independently correlated with urinary norepinephrine and SDS-BMI (P<0.05 for both), daytime diastolic BP (DBP) with waist circumference (P<0.05) and night-time SBP and DBP with SDS-BMI (P<0.01 for both). The risk of having systolic and diastolic hypertension increased with the increase in SDS-BMI and waist circumference, respectively. In conclusion, in our cohort of obese children and adolescents, daytime and night-time hypertension were associated with activation of the sympathoadrenal system and worst metabolic conditions, respectively.
Similar content being viewed by others
References
Genovesi S, Giussani M, Pieruzzi F, Vigorita F, Arcovio C, Cavuto S et al. Results of blood pressure screening in a population of school-aged children in the province of Milan: role of overweight. J Hypertens 2005; 23: 493–497.
Rosner B, Prineas RJ, Daniels SR, Loggie JMH . Blood pressure differences between blacks and whites in relation to body size among US children and adolescents. Am J Epidemiol 2000; 151: 1007–1019.
McCrory WW . Definition, prevalence and distribution of causes of hypertension. In: Loggie J (ed). Pediatric and Adolescent Hypertension. Blackwell Scientific: Cambridge, MA, 1992, pp 104–111.
Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ . Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 2004; 113: 475–482.
Invitti C, Gilardini L, Pontiggia B, Mazzilli G, Sartorio A, Morabito F . Prevalence and concomitance of high blood pressure in Italian obese children. J Hypertens 2005; 23: 1605–1606.
Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, et al., American Heart Association; Obesity Committee of the Council on Nutrition, Physical activity, and Metabolism. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association scientific statement on obesity and heart disease from the Obesity Committee of the Council on Nutrition, Physical activity, and Metabolism. Circulation 2006; 113: 898–918.
Gilardini L, McTernan PG, Girola A, da Silva NF, Alberti L, Kumar S et al. Adiponectin is a candidate marker of metabolic syndrome in obese children and adolescents. Atherosclerosis 2006; 24: 401–407.
Garanty-Bogacka B, Syrenicz M, Syrenicz A, Gebala A, Lulka D, Walczak M . Serum markers of inflammation and endothelial activation in children with obesity-related hypertension. Neuro Endocrinol Lett 2005; 26: 242–246.
Sorof J, Daniels S . Obesity hypertension in children: a problem of epidemic proportions. Hypertension 2002; 40: 441–447.
Boyd GS, Koenigsberg J, Falkner B, Gidding S, Hassink S . Effect of obesity and high blood pressure on plasma lipid levels in children and adolescents. Pediatrics 2005; 116: 442–446.
Williams DE, Cadwell BL, Cheng YJ, Cowie CC, Gregg EW, Geiss LS et al. Prevalence of impaired fasting glucose and its relationship with cardiovascular disease risk factors in US adolescents, 1999–2000. Pediatrics 2005; 116: 1122–1226.
Lurbe E, Invitti C, Torro I, Maronati A, Aguilar F, Sartorio A et al. The impact of the degree of obesity on the discrepancies between office and ambulatory blood pressure values in youth. J Hypertens 2006; 24: 1557–1564.
Belsha CW, Wells TG, McNiece KL, Seib PM, Plummer JK, Berry PL . Influence of diurnal blood pressure variations on target organ abnormalities in adolescents with mild essential hypertension. Am J Hypertens 1998; 11: 410–417.
Sorof JM, Cardwell G, Franco K, Portman RJ . Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension 2002; 39: 903–908.
Cacciari E, Milani S, Balsamo A, Dammacco F, De Luca F, Chiarelli F et al. Italian cross-sectional growth charts for height, weight and BMI (6–20 years). Eur J Clin Nutr 2002; 56: 171–180.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC . Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–419.
Menghetti E, Virdis R, Strambi M, Patriarca V, Riccioni MA, Fossali E et al. Blood pressure in childhood and adolescence: the Italian normal standards. Study Group on Hypertension of the Italian Society of Pediatrics. J Hypertens 1999; 17: 1363–1372.
Fagard R, Brguljan J, Thijs L, Staessen J . Prediction of the actual awake and asleep blood pressures by various methods of 24-h pressure analysis. J Hypertens 1996; 14: 557–563.
Casadei R, Parati G, Pomidossi G, Groppelli A, Trazzi S, Di Rienzo M et al. 24-h blood pressure monitoring: evaluation of Spacelabs 5300 monitor by comparison with intra-arterial blood pressure recording in ambulant subjects. J Hypertens 1988; 6: 797–803.
Soergel M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R et al. Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 1997; 130: 178–184.
Staessen JA, Bieniaszewski L, O'Brien E, Gosse P, Hayashi H, Imai Y, et al., The ‘Ad Hoc’ Working Group. Nocturnal blood pressure fall on ambulatory monitoring in a large international database. Hypertension 1997; 29: 30–39.
Lurbe E, Torro I, Alvarez V, Nawrot T, Paya R, Redon J et al. Prevalence, persistence, and clinical significance of masked hypertension in youth. Hypertension 2005; 45: 493–498.
Safar H, Chahwakilian A, Boudali Y, Debray-Meignan S, Safar M, Blacher J . Arterial stiffness, isolated systolic hypertension, and cardiovascular risk in the elderly. Am J Geriatr Cardiol 2006; 15: 178–182.
Masuo K, Mikami H, Itoh M, Ogihara T, Tuck ML . Sympathetic activity and body mass index contribute to blood pressure levels. Hypertens Res 2000; 23: 303–310.
Masuo K, Mikami H, Ogihara T, Tuck ML . Familial obesity, sympathetic activation and blood pressure level. Blood Press 2001; 10: 199–204.
Clausen JO, Ibsen H, Dige-Petersen H, Borch-Johnsen K, Pedersen O . The importance of adrenaline, insulin and insulin sensitivity as determinants for blood pressure in young Danes. J Hypertens 1995; 13: 499–505.
Beilin LJ, Vandongen R, Arkwright PD, Davidson L . Adrenal and sympathetic nervous activity in subjects with ‘low’ and ‘high’ normal blood pressure. J Hypertens 1983; 1: 13–18.
Masuo K, Mikami H, Ogihara T, Tuck ML . Familial hypertension, insulin, sympathetic activity, and blood pressure elevation. Hypertension 1998; 32: 96–100.
Freedman DS, Dietz WH, Srinivasan SR, Berenson GS . The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999; 103: 1175–1182.
Barba G, Troiano E, Russo P, Strazzullo P, Siani A . Body mass, fat distribution and blood pressure in Southern Italian children: results of the ARCA project. Nutr Metab Cardiovasc Dis 2006; 16: 239–248.
Goran MI, Gower BA . Relation between visceral fat and disease risk in children and adolescents. Am J Clin Nutr 1999; 70: 149S–156S.
Sinaiko AR, Steinberger J, Moran A, Hong CP, Prineas RJ, Jacobs Jr DR . Influence of insulin resistance and body mass index at age 13 on systolic blood pressure, triglycerides, and high-density lipoprotein cholesterol at age 19. Hypertension 2006; 48: 730–736.
Cruz ML, Huang TT, Johnson MS, Gower BA, Goran MI . Insulin sensitivity and blood pressure in black and white children. Hypertension 2002; 40: 18–22.
Poirier P, Lemieux I, Mauriège P, Dewailly E, Blanchet C, Bergeron J et al. Impact of waist circumference on the relationship between blood pressure and insulin: the Quebec Health Survey. Hypertension 2005; 45: 363–367.
Kaplan NM, Opie LH . Controversies in hypertension. Lancet 2006; 367: 168–176.
Feig DI, Johnson RJ . Hyperuricemia in childhood primary hypertension. Hypertension 2003; 42: 247–252.
Invitti C, Maffeis C, Gilardini L, Pontiggia B, Mazzilli G, Girola A et al. Metabolic syndrome in obese Caucasian children: prevalence using WHO-derived criteria and association with nontraditional cardiovascular risk factors. Int J Obes (Lond) 2006; 30: 627–633.
Forman JP, Brenner BM . ‘Hypertension’ and ‘microalbuminuria’: the bell tolls for thee. Kidney Int 2006; 69: 22–28.
Kotsis V, Stabouli S, Bouldin M, Low A, Toumanidis S, Zakopoulos N . Impact of obesity on 24-h ambulatory blood pressure and hypertension. Hypertension 2005; 45: 602–607.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gilardini, L., Parati, G., Sartorio, A. et al. Sympathoadrenergic and metabolic factors are involved in ambulatory blood pressure rise in childhood obesity. J Hum Hypertens 22, 75–82 (2008). https://doi.org/10.1038/sj.jhh.1002288
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jhh.1002288
- Springer Nature Limited
Keywords
This article is cited by
-
School-based surveillance on visit-to-visit blood pressure variability and high blood pressure in children and adolescents
BMC Cardiovascular Disorders (2021)
-
The relationship between body fat ratio and blood pressure in school-age children
Journal of Human Hypertension (2020)
-
Association between nocturnal blood pressure dipping and insulin resistance in children affected by NAFLD
European Journal of Pediatrics (2014)
-
Autonomic Nervous System Dysregulation in Pediatric Hypertension
Current Hypertension Reports (2014)
-
Heart Rate and the Cardiometabolic Risk
Current Hypertension Reports (2013)