184 research outputs found
Uric Acid and Hypertension: a Review of Evidence and Future Perspectives for the Management of Cardiovascular Risk
No full textUric acid is the final product of purine metabolism, and its increased serum levels have been directly involved in the pathogenesis and natural history of hypertension. The relationship between elevated uric acid and hypertension has been proven in both animals and humans, and its relevance is already evident in childhood and adolescent population. The mechanism responsible for blood pressure increase in hyperuricemic subjects is implicating both oxidative stress and intracellular urate activity with a primary involvement of XOR (xanthine-oxidoreductase activity). An increase in the relative risk of hypertension has been confirmed by genetic data and by large meta-analyses of epidemiological data. The effects of urate-lowering treatment on blood pressure control in patients with elevated serum uric acid has been investigated in a small number of reliable studies with a large heterogeneity of patient populations and study designs. However, 2 large meta-analyses suggest a significant effect of urate-lowering treatment on blood pressure, thus confirming the significant relationship between high serum urate and blood pressure. The future research should be focused on a more appropriate identification of patients with cardiovascular hyperuricemia by considering the correct cardiovascular threshold of serum urate, the time-course of uricemia fluctuations, and the identification of reliable markers of urate overproduction that could significantly clarify the clinical and therapeutic implications of the interaction between serum uric acid and hypertension
Uric acid is linked to cardiometabolic risk factors in overweight and obese youths
No full textObjective:Observational studies have indicated that high levels of serum uric acid are associated with the risk of cardiovascular disease. The aim of the present study is to investigate the association of uric acid with individual cardiometabolic risk factors, as well as their degree of clustering, in overweight and moderate obese youth.Methods:Three hundred and thirty-three Caucasians of both sexes (149 women), from 5-18 years of age from those who underwent an assessment of overweight/obesity. Anthropometric parameters, office and 24-h blood pressure measurements and metabolic profile, including HDL-cholesterol, triglycerides, insulin, HOMA index and uric acid were assessed.Results:Uric acid was significantly higher in boys than in girls. A positive significant association between uric acid, and office, daytime and night-time SBP, insulin and triglycerides was observed. When boys and girls were grouped by sex-specific uric acid tertiles, a progressive increment was observed in BMI, BMI z-score and waist circumference as well as fasting insulin and HOMA index. In boys, this was also present in office and ambulatory SBP. Likewise, the number of abnormal metabolic risk factors also increases with the uric acid values and the higher the number of metabolic components the higher the uric acid values. Moreover, in a multiple regression analysis, uric acid was significantly related with male sex, waist circumference, both office and night-time SBP and birth weight.Conclusion:The present study found a positive association between uric acid and blood pressure, insulin and triglycerides. As uric acid levels increase there is a relevant clustering of metabolic risk factors, whereas elevated blood pressure is the risk factor less frequently present. Further studies need to assess the mechanistic link between uric acid and the cardiometabolic risk factors
Significado de la hipertensión arterial enmascarada en niños y adolescentes
No full textLa Hipertensión Arterial Enmascarada (HTAe) en niños y adolescentes es una condición prevalente, persistente y con impacto clínico. Las características clínicas que presentan los jóvenes en riesgo de sufrir HTAe no están definidas. Además, hasta el momento, no ha sido establecido cuál es el riesgo de desarrollar hipertensión arterial persistente (HTAp) de los niños y adolescentes con HTAe, ni los factores de riesgo asociados a esta condición.
Con el objetivo de estudiar estos aspectos, se ha realizado un estudio prospectivo a largo plazo, evaluando la progresión de los valores de presión arterial clínica y ambulatoria así como la antropometría de un grupo de niños y adolescentes normotensos (NT) y otro con HTAe. Las características clínicas que podrían identificar a los niños y jóvenes en riesgo de sufrir HTAe y el potencial dimorfismo sexual en la incidencia y momento de aparición de HTAp han sido analizados.
En este estudio prospectivo a largo plazo (seguimiento medio de 36 meses), participaron 272 niños y adolescentes sanos (edad entre 6 y 18 años, 55,8% niñas), normotensos por determinación de presión arterial clínica, de los cuáles 39, presentaban HTAe al inicio del estudio. Cuando se comparan las características clínicas de ambos grupos al inicio del estudio no encontramos diferencias en cuanto a edad, sexo, valor de PA o antropometría, pero los antecedentes familiares de primer grado de HTA eran significativamente mayores en los varones con HTAe frente a los NT (50% vs 23,1%, p<0,05) y también en mujeres (21,7% Vs 18,6%, p=ns), pero no de forma significativa. El desarrollo de HTAp (HTA tanto por PA clínica como por presión arterial ambulatoria (MAPA)) en los participantes, fue registrado. LA PA sistólica clínica, desde la determinación inicial hasta la última medición realizada en el seguimiento se incrementó significativamente en los varones (3,2 mmHg por año, p<0,0001), pero no en las mujeres (1,2 mmHg por año, p=0,062). Algo similar ocurrió con la PA sistólica diurna determinada por MAPA, varones (1,14 mmHg por año, p<0.05) Vs mujeres (-0,23 mmHg, anuales, p=ns), lo que denota una diferencia significativa entre sexos (p=0,0022).
La incidencia de HTAp fue de 7/100 sujetos anual (n=12)entre los HTAe y de 0,6/100 sujetos anual (n=4) entre los NT. Los varones con HTAe desarrollaron HTAp en una proporción significativamente mayor que las mujeres con HTAe (50% versus 17,4%; p=0,041).
La presencia de HTAe en la valoración basal fue el determinante más importante para desarrollar HTAp (HR 15,6; 95th CI 4,91-49,7; p<0,0001). También el sexo masculino implicó mayor riesgo (HR 3,25; CI 1,12-9,39; p=0,0295).
En niños y adolescentes, la HTAe es una precursora de HTAp. Los antecedentes parentales de HTA podrían ser un marcador clínico de riesgo de presentar HTA e por lo que estos niños serían candidatos de estudiarse mediante MAPA. El riesgo de desarrollar HTAp es superior en varones que en mujeres. El hecho de que la HTAe no sea una condición inocente, incrementa la necesidad de su diagnóstico precoz y un seguimiento adecuado, por lo que proponemos un algoritmo de diagnóstico y seguimiento de estos pacientes.Masked Hypertension (MK) in children and adolescents is prevalent, persistent and with clinical significance condition. Clinical characteristics of youth at risk of MK are not defined. Also, so far, has not been established what is the risk of developing sustained hypertension (SH) in children and adolescents with MK or the risk factors associated with.
In order to study these aspects, we performed a long-term follow-up study assessing how hypertension develops over time in healthy, masked hypertensive youths.The clinical characteristics that could identify children and youth at risk of MK and the potential sexual dimorphism in the incidence and timing of the development of SH have been analyzed.
In this prospective long-term study (mean follow-up of 36 months), we enrolled 272 healthy conventional normotensive children and adolescents (aged 6 to 18 years, 55.8% female), of whom 39 had MK at baseline. Clinical characteristics of both groups were compared at baseline founding no differences in age, sex, anthropometry and BP value, but the first-degree family history of hypertension was significantly higher in boys with HTAe compared to NT (50% vs 23.1%, p <0.05) and in girls (21.7% vs. 18.6%, p = ns), but not significantly. Development of SH (HTN both clinic BP and ambulatory blood pressure (ABPM) in participants was recorded. Clinic systolic BP, from baseline to the last avaliable follow-up significantly increased in boys (3.2 mmHg per year, p <0.0001) but not in girls (1.2 mm Hg per year , p = 0.062). Something similar happened with daytime systolic BP determined by ABPM, boys (1.14 mmHg per year, p <0.05) vs girls (-0.23 mmHg, year, p = ns), leading to a significant between-sex difference (p = 0.0022). The incidence of sustained hypertension was 7.0/100 subjects/y (n=12) in masked hypertensives and 0.6/100 subjects/y (n=4) in normotensives. Masked hypertensive boys more frequently proceeded to sustained hypertension as compared with masked hypertensive girls (50.0% versus 17.4%; P =0.041). Masked hypertension at baseline (hazard ratio, 15.6; 95% confi dence interval, 4.91 – 49.7; P < 0.0001) and male sex (hazard
ratio, 3.25; 95% confi dence interval, 1.12 – 9.39; P =0.0295) were independent factors associated with the incidence of sustained hypertension during the follow-up.
In children and adolescents, MK is a precursor of SH. Parental history of hypertension may be a clinical marker of risk for hMK and so, these children would be candidates for study by ABPM The risk of developing SH is higher in boys than in girls. The fact that MK not prognostically innocent, increases the need for early diagnosis and appropriate monitoring. We propose an algorithm for diagnosis and management of these patients
- …
