Metabolic and Hemodynamic Features of Arterial Hypertension in Adolescents Depending on Body Weight

M.M. Koreniev, L.F. Bohmat, V.V. Nikonova, O.M. Nosova, I.M. Bessonova


In recent years, the special attention has been concentrated on problems related to metabolic violations, the role of leading risk factors of prognosis for arterial hypertension (AH) course, but there is a lack of such researches among children and adolescents. A comprehensive survey of 142 young males with AH newly diagnosed at the age of 13–18 years has been carried out. Control group included 21 apparently healthy adolescents with normal blood pressure (BP) and body weight. Physical development was assessed based on anthropometric parameters and body mass index (BMI). Three subgroups of adolescents with AH were pointed out taking into account BMI. 24-hour blood pressure monitoring, echocardiography were carried out, parameters of carbohydrate and lipid metabolism and uric acid levels were studied. Statistical analysis of the material was held on the IBM PC/Pentium 4 using application package SPSS 17.0.
Indicators of diurnal BP profile differed a little by type, but only adolescents with AH and obesity reported all known pathological types of circadian BP profile. When assessing hypertension time index depending on body weight it was found that patients with AH and normal body weight both in the day time and in the night time recorded labile nature of systolic and diastolic hypertension. In young males with AH and overweight (OW) rates of hypertension during the day were within normal limits, and at night there was an increase to labile values, the same trend was characteristic of adolescents with AH and obesity.
Analysis of the morphological characteristics of the heart in adolescents with AH and overweight established a reliable thickening of left ventricular myocardium, both in posterior wall (p < 0.01) and interventricular septum (p < 0.05), a significant increase in aorta diameter (p < 0.05). Left ventricular, right ventricular, left atrial cavities were also dilated compared with the same in controls and adolescents with AH and normal body weight. In young males with AH and obesity, left and right ventricles (p < 0.001 and p < 0.01), aortic root (p < 0.01) were even larger, as well as left ventricular mass index was biggest (p < 0.01). When studying general hemodynamic performance in young males with AH depending on body weight, it was noted a trend to formation of hypokinetic hemodynamics due to reduced cardiac output and increased general vascular resistance both in patients with AH and OW and in adolescents with AH and obesity.
During the study of blood lipids in young males with AH, it was found that the level of total cholesterol, triglycerides and atherogenic index in adolescents with AH and OW, as well as with obesity significantly increased compared to the values in controls and young males with AH and normal body weight (p < 0.05; p < 0.01). And parameters of high density lipoprotein cholesterol were significantly reduced. In the same groups of adolescents we have detected an increase in immunoreactive insulin, besides, its level raised with increasing body weight. Insulin resistance of varying degrees has been detected significantly more often in adolescents who had OW (67.3 %) and obesity (77.5 %) and much less often in adolescents with AH and normal body weight (40.0 %) (p < 0.01). In patients with AH and normal body weight and overweight, mean values of uricemia did not differ significantly (p > 0.1), but in young males with AH and obesity significantly exceeded the rates in patients with AH and overweight (p < 0.05).
It is believed that disorders of purine, carbohydrate metabolism and blood lipids both in patients with AH and AH with obesity should be considered from the standpoint of endothelial dysfunction. Percentage of artery diameter increase after reactive hyperemia in adolescents with AH and normal body weight reached 14.2 % that corresponded to normal values, but in 40.9 % of adolescents this figure was below 10 %. When conducting tests with nitroglycerin, it was found that brachial artery diameter 5 minutes after its measurement in the group with AH and normal weight was 0.52 cm, corresponding to 23.8% growth, in patients with AH and OW — 0.50 cm, respectively 11.1% increase from baseline values, and in young males with AH and obesity — 0.52 cm, which was only 15.5% increase. Furthermore, 10 minutes after the test with nitroglycerin, in patients with AH and OW growth of the brachial artery diameter (+4.05 %) continued, in contrast to boys with AH and normal body weight and with AH and obesity, in whom reduction in brachial artery diameter (–5.81 and –3.83 %, respectively) was noted, which is a normal reaction to nitroglycerin elimination from bloodflow.
Thus, in adolescents with AH at raised body mass index, the prevalence and depth of endothelial dysfunction (in tests of endothelium-dependent and endothelium-independent vasodilation) increased that is closely correlated with the disturbances in blood lipids, carbohydrate and purine metabolism. There were pointed out the components which are most important for endothelial dysfunction in adolescents with AH and overweight and obesity, namely disorders in lipid metabolism, purine and insulin resistance.


adolescents; arterial hypertension; carbohydrate metabolism; lipid profile; hyperuricemia


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