Objective To compare neurocognitive test performance of children with primary hypertension with that of normotensive controls. Study design Seventy-five children (10-18 years of age) with newly ...diagnosed, untreated hypertension and 75 frequency-matched normotensive controls had baseline neurocognitive testing as part of a prospective multicenter study of cognition in primary hypertension. Subjects completed tests of general intelligence, attention, memory, executive function, and processing speed. Parents completed rating scales of executive function and the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ-SRBD). Results Hypertension and control groups did not differ significantly in age, sex, maternal education, income, race, ethnicity, obesity, anxiety, depression, cholesterol, glucose, insulin, and C-reactive protein. Subjects with hypertension had greater PSQ-SRBD scores ( P = .04) and triglycerides ( P = .037). Multivariate analyses showed that hypertension was independently associated with worse performance on the Rey Auditory Verbal Learning Test (List A Trial 1, P = .034; List A Total, P = .009; Short delay recall, P = .013), CogState Groton Maze Learning Test delayed recall ( P = .002), Grooved Pegboard dominant hand ( P = .045), and Wechsler Abbreviated Scales of Intelligence Vocabulary ( P = .016). Results indicated a significant interaction between disordered sleep (PSQ-SRBD score) and hypertension on ratings of executive function ( P = .04), such that hypertension heightened the association between increased disordered sleep and worse executive function. Conclusions Youth with primary hypertension demonstrated significantly lower performance on neurocognitive testing compared with normotensive controls, in particular, on measures of memory, attention, and executive functions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objective To examine the relative effects of high blood pressure (HBP) and obesity on left ventricular mass (LVM) among African-American adolescents; and if metabolic or inflammatory factors ...contribute to LVM. Study design Using a 2 × 2 design, African-American adolescents were stratified by body mass index percentile (body mass index <95th percentile = non-obese; ≥95th percentile = obese) and average blood pressure (BP) (normal BP <120/80 mm Hg; HBP ≥120/80). Glucose, insulin, insulin resistance, lipids, and inflammatory cytokines were measured. From echocardiography measures of LVM, calculated LVM index (LVMI) ≥95th percentile defined left ventricular hypertrophy (LVH). Results Data included 301 adolescents (48% female), mean age 16.2 years, 51% obese, and 29% HBP. LVMI was highest among adolescents with both obesity and HBP. The multiplicative interaction of obesity and HBP on LVH was not significant (OR = 2.35, P = .20) but the independent additive associations of obesity and HBP with log-odds of LVH were significant; obesity OR = 3.26, P < .001; HBP OR = 2.92, P < .001. Metabolic and inflammatory risk factors were associated with obesity, but had no independent association with LVMI. Compared with those with average systolic BP (SBP) <75th percentile, adolescents with SBP from the 75th percentile to 90th percentile had higher LVMI (33.2 vs 38.7 g/m2.7 , P < .001) and greater LVH (18% vs 43%, P < .001), independent of obesity. Conclusions Prevalence of LVH is highest among African-American adolescents with average BP ≥120/80 mm Hg and obesity. There also is an independent association of LVMI with BP, beginning at the 75th SBP percentile.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objectives To determine the efficacy of 4 g/day fish oil to lower triglycerides and impact lipoprotein particles, inflammation, insulin resistance, coagulation, and thrombosis. Study design ...Participants (n = 42, age 14 ± 2 years) with hypertriglyceridemia and low-density lipoprotein (LDL) cholesterol <160 mg/dL were enrolled in a randomized, double-blind, crossover trial comparing 4 g of fish oil daily with placebo. Treatment interval was 8 weeks with a 4-week washout. Lipid profile, lipoprotein particle distribution and size, glucose, insulin, high-sensitivity C-reactive protein, interleukin-6, fibrinogen, plasminogen activator inhibitor-1, and thrombin generation were measured. Results Baseline lipid profile was total cholesterol 194 (5.4) mg/dL (mean SE), triglycerides 272 (21) mg/dL, high-density lipoprotein cholesterol 39 (1) mg/dL, and LDL cholesterol 112 (3.7) mg/dl. LDL particle number was 1614 (60) nmol/L, LDL size was 19.9 (1.4) nm, and large very low-density lipoprotein/chylomicron particle number was 9.6 (1.4) nmol/L. Triglycerides decreased on fish oil treatment but the difference was not significant compared with placebo (−52 ± 16 mg/dL vs −16 ± 16 mg/dL). Large very low-density lipoprotein particle number was reduced (−5.83 ± 1.29 nmol/L vs −0.96 ± 1.31 nmol/L; P < .0001). There was no change in LDL particle number or size. There was a trend towards a lower prothrombotic state (lower fibrinogen and plasminogen activator inhibitor-1; .10 > P > .05); no other group differences were seen. Conclusions In children, fish oil (4 g/day) lowers triglycerides slightly and may have an antithrombotic effect but has no effect on LDL particles.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objectives Fibroblast growth factor-23 (FGF23) is a biomarker for cardiovascular disease. Obesity may promote FGF23 production in the absence of chronic kidney disease. We sought to determine among ...normotensive African American adolescents whether FGF23 levels are greater in obese compared with normal-weight adolescents and to determine the relationship of FGF23 with markers of cardiac structure and insulin resistance. Study design Cross-sectional data were obtained from a cohort of 130 normotensive, African American adolescents ages 13-18 years without chronic kidney disease; 74 were obese; 56 were normal weight. Plasma C-terminal FGF23, fasting glucose and insulin, and high-sensitivity C-reactive protein were measured; participants underwent M-mode echocardiography. Results FGF23 was skewed and approximately normally distributed after natural log transformation (logFGF23). FGF23 levels were greater in obese vs normal-weight participants (geometric mean 43 vs 23 RU/mL, P < .01). FGF23 values were significantly greater in participants with eccentric or concentric cardiac hypertrophy compared with those without hypertrophy P < .01). LogFGF23 directly correlated with body mass index, body mass index z-score, waist circumference, fasting insulin levels, and homeostasis model assessment scores. Regression models adjusted for age, sex, and high-sensitivity C-reactive protein suggest that each 10% increase in FGF23 is associated with a 1.31 unit increase in left ventricular mass ( P < .01), a 0.29-unit increase in left ventricular mass index ( P < .01), and a 0.01-unit increase in left atrial dimension indexed to height ( P = .02). Conclusions In this sample of obese African American adolescents, FGF23 blood levels were associated with abnormal cardiac structure. We postulate that FGF23 may be an early marker of cardiac injury in obese but otherwise-healthy African American adolescents.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objective To determine the change in parental ratings of executive function and behavior in children with primary hypertension after anti-hypertensive therapy. Study design Parents of subjects with ...untreated hypertension and control subjects completed the Behavior Rating Inventory of Executive Function (BRIEF) to assess behavioral correlates of executive function and the Child Behavior Checklist (CBCL) to assess internalizing and externalizing behaviors. Subjects with hypertension subsequently received anti-hypertensive therapy to achieve casual blood pressure (BP) <95th percentile. After 12 months, all parents again completed the BRIEF and CBCL. Results Twenty-two subjects with hypertension and 25 normotensive control subjects underwent both baseline and 12-month assessments. The BP of subjects with hypertension improved (24-hour systolic BP SBP load: mean baseline versus 12-months, 60% versus 25%, P < .001). Parent ratings of executive function improved from baseline to 12 months in the subjects with hypertension (BRIEF Global Executive Composite T-score, Δ = –5.9, P = 0.001), but not in the normotensive control subjects (Δ = –0.36, P = .83). In contrast, T-scores on the CBCL Internalizing and Externalizing summary scales did not change significantly from baseline to 12 months in either subjects with hypertension or control subjects. Conclusions Children with hypertension demonstrated improvement in parental ratings of executive function after 12 months of anti-hypertensive therapy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objective To determine the relations between hypertension and parental ratings of behavior and executive functions in children with primary hypertension and to examine the potential moderating ...influence of obesity. Study design Hypertensive and normotensive control groups were matched for age, sex, race, intelligence quotient, maternal education, household income, and obesity. Parents completed the Child Behavior Checklist to assess Internalizing and Externalizing problems and the Behavior Rating Inventory of Executive Function to assess behavioral correlates of executive function. Results Thirty-two hypertensive subjects and 32 normotensive control subjects (aged 10 to 18 years) were enrolled. On the Child Behavior Checklist, hypertensives had higher Internalizing T-scores (53 vs 44.5, P = .02) with 37% falling within the clinically significant range vs 6% of control subjects ( P = .005). Internalizing score increased with increasing body mass index percentile in hypertensive but not normotensive subjects. Hypertensives had worse Behavior Rating Inventory of Executive Function Global Executive Composite T-scores compared with control subjects (50 vs 43, P = .009). Conclusions Children with both hypertension and obesity demonstrate higher rates of clinically significant internalizing problems, and hypertensives (irrespective of obesity) demonstrate lower parental ratings of executive function compared with normotensive control subjects.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Left ventricular hypertrophy has been documented in hypertensive adolescents and among some with prehypertension. Obesity also appears to be associated with cardiac mass, independent of blood ...pressure (BP). Fibroblast growth factor 23 (FGF23) is a novel biomarker positively associated with left ventricular hypertrophy in adults with and without kidney disease. The aim of this study was to determine if there was a significant and independent association of FGF23 with cardiac mass in a Black American adolescent cohort including both normotensive and prehypertensive participants with and without obesity. Measurements of BP, body mass index (BMI), plasma c-terminal FGF23, and echocardiographic measures of left ventricular mass index (LVMI) were obtained in 236 adolescents, aged 13-18 years, stratified by BMI as normal, overweight, or obese. LVMI differed significantly between normal, overweight, and obese groups (30.42 ± 6.75 vs. 33.49 ± 8.65 vs. 37.26 ± 6.99 gm/m
; P < .01). FGF23 was significantly higher in both overweight (53.03 RU/mL) and obese (54.40 RU/mL) compared to the normal weight (32.83 RU/mL) group (both P < .01). In multiple linear regression analysis, variables significantly related to LVMI in males were BMI (P < .0001) and FGF23 (P = .005), but not BP, high-sensitivity C-reactive protein, or insulin. The only significant variable associated with LVMI in females was BMI (P < .0001). In males, the contribution of FGF23 to predicting LVMI was independent of and in addition to obesity. These results suggest that FGF23 is an integral part of a complex pathway, associated with higher cardiac mass in African-Americans males with excess adiposity.
C-reactive protein (CRP) is related to adiposity and metabolic risk and predicts events in adults. The objective was to determine if relationships between adiposity and CRP have similar magnitudes in ...adolescents as adults.
Healthy African Americans (484 adults and 282 adolescents) were recruited from similar environments. In both cohorts, measurements included anthropometrics, blood pressure (BP), metabolic risk factors and inflammatory markers. After stratification by high-sensitivity CRP (hsCRP: ≤1, 1-≤3, >3 mg/dL), adults and adolescents were compared with regard to body mass index (BMI; kg/m), waist circumference (WC; cm), BP and other risk factors. hsCRP was regressed on BMI and WC with covariates including cohort, age, sex, BP, insulin resistance, smoking, alcohol and other biomarkers. Interaction terms and a subset of the covariates were subject to a supervised variable selection procedure for a final model. Skewed variables were log transformed and summarized by geometric means (GMs) with 1st and 3rd quartiles (Q1, Q3).
Among adolescents (16.3%) and adults (34.1%) having high hsCRP(>3 mg/dL), BMI was distributed similarly (GM = 36.4 32.7, 43.1 and GM = 34.7 28.8, 40.8, respectively) as was WC (GM = 104.2 93.0, 119.0 and GM = 104.9 93.0, 117.2, respectively). In an adjusted regression model, for a given BMI, elevated WC was associated with elevated hsCRP (P = 0.02). Although elevated BMI was significantly associated with elevated hsCRP, the relationship was stronger among adolescents (interaction P = 0.04).
These findings demonstrate that, in African Americans, obesity is associated with inflammation and adverse changes in metabolic parameters among both adolescents and young adults.
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