Clinical characteristics of young-onset and medical treatment-requiring hypertension identified by targeted screening in university health check-up

Based on targeted screening for hypertension at a university health check-up, we previously reported a high incidence of white-coat hypertension and estimated prevalence of hypertension requiring medical treatments (HT) as around 0.1% in young population aged less than 30. In spite of such low prevalence, continuous screening for seven consecutive years (2003-2009) increased the number of HT students to 20 (19 males and 1 female). We presently assessed the clinical characteristics of these HTs. Renovascular hypertension was found in the only female HT and aortic valve regurgitation in two HTs. Resting 17 HTs were diagnosed as having essential hypertension (EH). A father and/or a mother had EH in 16 out of 17 EHs, and blood pressure (BP) at home was slightly elevated (135-145 mm Hg in systolic) except three obese EHs (body mass index more than 30) who demonstrated more than 160 mm Hg in systolic. Plasma aldosterone-renin ratio (ARR) of EHs did not differ from that of normal controls, and Pearson correlation coefficient (R) between ARR and systolic BP (SBP) was -0.2. Its partial correlation coefficient, however, was statistically significant (R = -0.55, P = .026) after correcting for body mass index, which was significantly correlated with both SBP (P = .006, after correcting for ARR) and ARR (P = .004, after correcting for SBP). In conclusion, most of young-onset HTs are male EHs, and aortic valve regurgitation should be carefully checked. Excess plasma renin activity would be one of additional characteristics of young-onset EH to male gender, genetic background, and increased body mass.     

血管内皮功能与运动后血压反应相关性的研究

目的:研究原发性高血压(EH)患者的内皮依赖性血管舒张功能与运动后血压反应的关系。方法:对53例EH(EH组)患者及42例正常人(对照组),采用高分辨率血管超声进行内皮依赖性血管舒张功能的检测,采用平板运动试验系统进行亚极量运动负荷试验,于运动前、达亚极量负荷后即刻及休息 6 min后测定血压。结果:除2例患者运动前血压≥160/100 mmHg(1 mmHg=0.133 kPa)被除外,其余患者均完成试验。与运动前比较,运动后即刻收缩压在对照组及EH组均显著升高(对照组:P<0.05,EH组: P<0.01),且 EH组的升高幅度较对照组显著(P<0.01),舒张压仅EH组显著升高(P<0.01);运动后6min两组的血压较运动前差异无统计学意义。EH组的内皮依赖性血管舒张功能(FMD%)较对照组显著减低(P<0.05)。运动后舒张压差值与FMD%呈显著负相关( r=-0.809, P<0.01),但收缩压与 FMD%无相关关系( r=-0.296, P>0.05)。结论:运动可使EH患者血压升高,但很快恢复;运动后收缩压升高与内皮依赖性舒张功能无关,而舒张压升高与之密切有关。     

Association Analyses of SA Gene Variant in Essential Hypertensives

A gene designated S_A has been implicated in hypertension (HT) in rat genetic models and Japanese HT patients. However, a linkage study in whites was negative. Because of the limitations of genetic analyses, confirmation in different settings is imperative. Therefore, we conducted a cross-sectional case-control study involving 106 HT and 96 normotensive (NT) white subjects. A polymerase chain reaction technique was developed for PstI restriction fragment length polymorphism (RFLP) determination. We could find no association of this RFLP with HT (frequency of minor allele, A2 = 0.11 in HTs v 0.07 in NTs). However, A2 displayed an association with increase in body mass index in HTs: for a body mass index mean of 26 kg/m² or more, A2 = 0.17 compared to 0.06 for body mass index of less than 26 kg/m² (χ² = 6.4, P = .01; odd ratio 3.4, 95% confidence interval 1.2 to 10.0); for a body mass index of 28 kg/m² or more, A2 = 0.20 (χ² = 10.4, P = .001; odds ratio 4.0, 95% confidence interval 1.5 to 10.5). Furthermore, A2 tracked significantly with elevation in body mass index in the HTs (F = 4.8, P = .01 by one-way ANOVA). In conclusion, we could find no association of S_A genotype with HT, but obtained preliminary evidence for a possible association with variation in body mass index in a severely affected HT group with a strong family history of HT.     

Lack of Association Between Blood Pressure Variability and Left Ventricular Mass in Essential Hypertension

Blood pressure (BP) variability could induce detrimental effects on left ventricular (LV) structure in hypertension. We investigated the association between short-term BP variability, assessed with 24-h noninvasive ambulatory BP monitoring, and LV mass at echocardiography in 1822 untreated subjects (953 men, 869 women) with essential hypertension (EH). The standard deviation (SD) of daytime and night-time systolic BP (SBP, r = 0.13/0.10; both P < .001), but not of diastolic BP, showed a weak correlation with LV mass. Because the SD of daytime SBP showed a direct association with average 24-h SBP (r = 0.27), subjects were ranked into quartiles of the distribution of 24-h SBP. For each quartile, the subjects with SD of daytime (and night-time) SBP below or above the median were classified at low or high BP variability. In both genders, subjects with high daytime SBP variability were older than those at low variability (both P < .01). Within each quartile, LV mass did not differ between the groups at low v those at high SBP variability. Overall, age-adjusted LV mass index was 115 and 115 g/m² in men at low and high daytime SBP variability (P = .84), and 116 and 114 g/m² in men at low and high nighttime SBP variability (P = .31). The corresponding values in women were 98 and 99 g/m² (P = .53) and 98 and 99 g/m² (P = .64). In conclusion, when the effects of age, gender, and average 24-h BP are taken into account, short-term BP variability assessed with noninvasive monitoring is unrelated to LV mass in subjects with EH.     

代谢综合征各组分与原发性高血压患者血压晨峰发生的相关性

目的:探讨代谢综合征(MS)各组分与原发性高血压（EH）患者血压晨峰（MBPS）发生的相关性。方法: 回顾性分析了在山东省章丘市农村入选的EH患者322例,根据患者是否并发有MS将患者分为并发MS组（n=126）和单纯EH组（n=196）,所有患者监测24h动态血压,比较两组患者血压晨峰发生情况。结果: 并发MS组患者24hSBP、白天(d)SBP、夜间(n)SBP、24 h脉压(PP)、dPP、nPP、MBPS值均显著高于单纯EH组,差异有统计学意义（P<0.05或P<0.01）。并发MS组患者MBPS发生率为60.3%显著高于单纯EH组,差异有统计学意义（P<0.01）。Pearson相关分析显示,MBPS与年龄、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油、低密度脂蛋白胆固醇、SBP、PP、体质量指数及腰围呈正相关,相关系数分别为0.38,0.44,0.48,0.26,0.35,0.38,0.34,0.21和0.43,P<0.05或P<0.01。多元线性逐步回归分析显示,TC、年龄、FPG、SBP及腰围是影响EH并发MS患者出现MBPS的主要危险因素（P<0.05或P<0.01）。结论: MS与MBPS的发生密切相关,其组分FPG、SBP及腰围是影响MBPS发生的主要危险因素。     

Relation of hypertension and glucose tolerance impairment in elderly people to the development of arteriosclerosis: Investigation using pulse wave velocity*

Background: The aim of the present study was to determine the correlation between the combination of hypertension and diabetes mellitus and arteriosclerosis using pulse wave velocity (PWV). Methods: The subjects were 186 men over the age of 60 years (mean age: 68.8 ± 5.8 years). PWV, systolic blood pressure (SBP), diastolic blood pressure, body mass index, fasting blood sugar (FBS), total cholesterol, triglyceride and HDL cholesterol were measured in all subjects. The subjects were divided into three groups on the basis of FBS level: a normal group (FBS < 110 mg/dL), an impaired fasting glucose group (110 ≤ FBS < 126 mg/dL) and a diabetes mellitus group (FBS ≥ 126 mg/dL or taking antidiabetics). The subjects were also divided into two groups on the basis of blood pressure level: a hypertension (HT) group (SBP ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg or taking antihypertensives) and a normotension group (other subjects). Results: PWV showed positive correlations with SBP and FBS (r = 0.499 and r = 0.300, respectively). In all three groups classified by FBS level, PWV was higher in subjects with HT than in subjects with normotension (P < 0.01 in all three groups). In the HT group, PWV had already increased at the stage of impaired fasting glucose and was significantly higher in the diabetes mellitus group than in the normal FBS group (P = 0.002). In multiple regression analysis using PWV as a dependent variable, SBP and FBS were selected as independent variables. Conclusions: Even in the elderly, strict control of blood pressure and blood sugar level may be necessary in order to prevent the development of arteriosclerotic diseases.     

Similar effects of isolated systolic and combined hypertension on left ventricular geometry and function: the LIFE study

Echocardiograms of 143 patients with isolated systolic hypertension were compared to 808 patients with combined (systolic and diastolic) hypertension. All patients met electrocardiographic criteria for left ventricular hypertrophy and were evaluated off medication. Patients with isolated systolic hypertension were older, shorter, weighed less, and were mostly women, but body mass index (BMI) was similar in both groups. Systolic blood pressure (SBP) was 172 mm Hg in isolated systolic hypertension, 174 mm Hg in combined (P = not significant). Diastolic blood pressure was 83 and 101 mm Hg, respectively (P < .001). Despite having mean arterial pressure 12 mm Hg lower than patients with combined hypertension, the group with isolated systolic hypertension had equally severe abnormalities of left ventricular mass, left ventricular geometric patterns, and measures of systolic and diastolic function. Peripheral resistance was lower and pulse pressure/stroke volume ratio (arterial stiffness index) was higher and the isovolumic relaxation time shorter in isolated systolic hypertension. Multiple regression analyses identified age, height, BMI, stress-corrected mid wall shortening, stroke volume, male gender, and systolic or mean blood pressure (but not isolated systolic hypertension) as independent correlates of left ventricular mass. Relative wall thickness was independently associated with isolated systolic hypertension (P = .001) in addition to mean pressure and other covariates. The present results add support to the concept that systolic blood pressure (SBP) is a stronger determinant than diastolic pressure of cardiac target organ damage in hypertension.     

2型糖尿病合并原发性高血压患者的动态血压及脉压和左心室结构功能的关系

目的 :探讨 2型糖尿病 (DM)、原发性高血压 (EH)及DM +EH时 2 4小时动态血压和脉压的变化特点及与左心室结构和功能的关系。　　方法 :将 2 45例患者分为DM组 (n =72 )、EH组 (n =96)及DM +EH组 (n =77) ,进行动态血压及超声心动图检查。　　结果 :DM +EH组全天收缩压、全天脉压、左心室重量显著大于DM组及EH组 (P <0 0 5 )。左心室射血分数、短轴缩短率、舒张早期血流峰值速度 /舒张晚期血流峰值速度 (E/A)值、等容舒张时间 3组间无显著差异。相关分析表明 ,DM组左心室重量和全天脉压相关 (P <0 0 1) ;EH组左心室重量和全天收缩压相关 (P <0 0 5 ) ;DM +EH组左心室重量和全天收缩压及全天脉压相关 (P <0 0 5 )。 3组左心室舒张功能异常患者的全天收缩压、全天脉压均显著高于左心室舒张功能正常患者 (P均 <0 0 5～ 0 0 1) ,左心室的收缩功能正常患者和异常患者比较 ,2 4小时动态血压和脉压值均无显著差异 (P均 >0 0 5 )。　　结论 :DM组、EH组和DM +EH组 3组患者全天收缩压、全天脉压及左心室重量有显著差异 ,左心室重量和血压及脉压的相关性在 3组患者中不完全一致 ,可能与 3组患者体液及压力因素在左心室肥厚中的作用各不相同有关。     

Serum aldosterone effect on left ventricular structure and diastolic function in essential hypertension

Aldosterone has hypertrophic and profibrotic effects on the heart. This study aims to determine the relationship between serum aldosterone concentration (SAC) and aldosterone-to-renin ratio (ARR) with left ventricular (LV) geometry and diastolic function in essential hypertension (EH). We investigated 213 EH patients (50.3 ± 12.6 years; 57.7% male). SAC, ARR measurements, and echocardiographic analysis were performed for participants. Overall, stepwise multiple regression analysis showed significant associations between SAC and interventricular septum, LV posterior wall thickness, LV amass, LV mass index, e′ velocity, a′ velocity, and E/e′ ratio after adjustment of potentially confounding covariates. When patients were divided into three SAC tertiles, multivariate-adjusted analysis of covariance (ANCOVA) demonstrated a significant increase in LV mass (P ˂ 0.001), LV mass index (P ˂ 0.001), relative wall thickness (P = 0.003), interventricular septum (P = 0.001), LV posterior wall thickness (P = 0.001) and E/e′ ratio (P ˂ 0.001), but a decrease in e′ velocity (P = 0.002) from the first to third tertile of SAC. In logistic regression analysis, increased SAC was independently associated with concentric LV hypertrophy [OR: 1.21, 95% CI: 1.11–1.33, P ˂ 0.001]. No significant associations were found between ARR and echocardiographic parameters of LV structure or diastolic function. In conclusion, SAC, but not ARR, is independently associated with echocardiographic indices of LV structure and diastolic function and is also related to concentric LV hypertrophy. Our findings suggest that aldosterone's pro-hypertrophic and myocardial fibrosis effects contribute to alterations in LV structure and diastolic function in EH beyond blood pressure.     

Microalbuminuria and early endothelial activation in essential hypertension

We hypothesized that in essential hypertensive patients (EHs), plasma levels of pro-atherogenic adhesion molecules would be increased and related with urine albumin excretion (UAE). Thus, this study was aimed at evaluating biochemical markers of endothelial activation and their relationship with UAE in a group of patients with uncomplicated EH. In basal condition soluble forms of adhesion molecules intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1, as well as 24-h UAE were assayed. One hundred patients with essential hypertension and no diabetes or ultrasonographic evidence of atherosclerosis were included in the study. Seventy normotensive healthy subjects served as controls. EHs were first studied overall, than were divided into two subgroups: those with UAE > or =20 mcg/min MAUs and those with UAE <20 mcg/min (non-MAUs). ICAM-1 (P<0.001) and VCAM-1 (P<0.0001) plasma concentrations were higher in EHs than in controls. Microalbuminuric EHs had greater levels of adhesion molecules than non-MAUs (ICAM-1 P=0.04; VCAM-1 P=0.02, respectively). In EHs UAE was correlated with ICAM-1 (r=0.29, P=0.003), and VCAM-1 (r=0.30, P=0.002). These associations were confirmed in multiple regression models (P=0.02 for both ICAM-1 and VCAM-1) including, along with adhesion molecules, age, body mass index and blood pressures. Our findings show that in essential hypertension there is a very early activation of endothelial adhesion molecules favouring atherosclerosis.     

高血压病合并2型糖尿病患者动态血压与CAVI及ABI相关性研究

目的探讨高血压病（EH）及合并2型糖尿病（T2DM）患者24 h动态血压水平及与心踝血管指数（CAVI）、踝臂指数（ABI）的相关性。方法随机入选90例高血压病患者,分为单纯高血压病组（EH组,n=47）,高血压病伴糖尿病组（EH＋T2DM组,n=43）。所有入选者进行24 h动态血压监测,CAVI、ABI指标及颈动脉超声检查。对两组上述指标进行比较,并对动态血压与CAVI、ABI进行直线相关分析。结果与EH组患者比较,EH＋T2DM组患者各时段的平均收缩压（SBP）、脉压（PP）、收缩压负荷（SBP-L）及CAVI呈增高趋势,而ABI和夜间血压下降率降低,两组比较均有统计学差异（P均〈0.05）。EH组患者杓型血压占42.5%,EH＋T2DM杓型血压占23.3%,两组比较有统计学差异（P〈0.05）。CAVI与24 h平均收缩压（24 hSBP）、夜间平均收缩压（nSBP）、24 h平均脉压差（24 hPP）、日间平均脉压差（dPP）、夜间平均脉压差（nPP）、夜间收缩压负荷（nSBP-L）、夜间舒张压负荷（nDBP-L）呈正相关,ABI与24 hSBP、白天平均收缩压（dSBP）、dPP、白天收缩压负荷（dSBP-L）、nSBP-L等指标呈负相关。结论合并T2DM可增加EH患者收缩压、脉压及收缩压负荷水平,并加速动脉硬化的进展。     

Fibroblast growth factor 23 (FGF23) gene polymorphisms are associated with essential hypertension risk and blood pressure levels in Chinese Han population

In this case-control study, 246 EH patients and 157 healthy controls were selected from Chinese Han population to explore the associations between the fibroblast growth factor 23 (FGF23) gene polymorphisms and essential hypertension (EH).The SequenomMassarray system was used for the genotyping of three FGF23 gene Tag single-nucleotide polymorphisms, namely rs7955866, rs13312756, and rs3812822. The primers were designed by Assay Designer 3.1 software, and then the samples were added to a 384-well plate for the polymerase chain reaction amplification, shrimp alkaline phosphatase reaction, and desalting after extension. The distributions of the alleles, genotypes, and haplotypes were compared between the two groups. Confounding factors (sex, age, BMI, smoking, and drinking) were adjusted in the non-logistic regression, and the results showed that rs7955866 and rs3812822 polymorphisms were independently associated with the risk of developing EH (P < 0.05). The statistical analysis of the haplotype of rs7955866-rs13312756-rs3812822 showed that haplotype ACC could increase the risk of developing EH (P = 0.046; OR = 1.513, 95%CI: 1.005–2.278). The analysis of the control group showed that carrying rs7955866 A allele (P = 0.031) and rs3812822 C allele (P = 0.025) was associated with the increase of systolic blood pressure (SBP). The insulin (INS) level in the peripheral blood was significantly different between the case and control groups (P = 0.014). After confounding factors were excluded, the results showed that the serum INS level was also an independent risk factor of developing EH (P = 0.044; OR = 1.604, 95%CI: 1.014–2.539). In summary, our results suggest that FGF23 gene polymorphisms are associated with the risk of developing EH in Chinese Han population.     

高血压病患者左室肥厚及构型改变与胰岛素抵抗的关系

目的:探讨高血压病(EH)患者胰岛素抵抗(IR)对左心室肥厚(LVH)和几何构型的影响。方法:检测124 例EH病人的左室重量指数(LVMI),相对室壁厚度(RWT),空腹血清葡萄糖(FSG)、空腹血胰岛素(FSI)浓度, 并计算胰岛素敏感性指数(ISI)。依照LVMI及RWT的数值124例EH病人被分为左室正常构型(51例),向心性构型(30例),向心性肥厚型(22例),离心性肥厚型(21例)。结果:RWT与年龄、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、平均心率呈正相关(r=0.16-0.22,P<0.05),与ISI呈负相关(r=-0.24),LVMI与SBP、DBP呈正相关(r=0.16-0.20,P<0.05),与ISI不相关。向心性重构组和向心性肥厚组年龄、RWT、HR、BMI大于正常构型组(P<0.05-<0.01),而ISI小于正常构型组(P<0.01)。结论:胰岛素敏感性降低与EH患者左心室肥厚无关,与RWT增加密切相关;ISI可能是EH患者发生左室向心性构型的重要影响因素之一。     

Byproducts of oxidative protein damage and antioxidant enzyme activities in plasma of patients with different degrees of essential hypertension

Despite evidence that essential hypertension (EH) is a state of increased oxidative stress, the data on oxidative protein modifications is lacking. Besides, the role of extracellular antioxidant enzymes in EH has not been systematically studied. Study was performed in 45 subjects with EH and 25 normotensive controls. Patients were divided into three groups according to the 2003 ESH/ESC guidelines (grade 1-3). Plasma protein reactive carbonyl derivatives (RCD) and SH-groups (as byproducts of oxidative protein damage) as well as antioxidant enzyme activities superoxide dismutase (SOD), glutathione peroxidase (GPX) and catalase were studied spectrophotometrically and correlated with blood pressure (BP). RCD levels were increased in EH patients compared to controls and correlated significantly with both systolic blood pressure (SBP) (r = 0.495, P<0.01) and diastolic blood pressure (DBP) (r = 0.534, P<0.01). Plasma SH-groups content was significantly lower in all patients with EH, with no correlation with BP. SOD and catalase activity in patients with grade 1 EH were similar to that of controls. Patients with grade 2 and 3 of EH had lower SOD and catalase activity. However, significant correlation with SBP and DBP was observed for catalase only (r = -0.331; P<0.05 and r = -0.365; P<0.05, respectively). EH patients exhibited higher plasma GPX activity compared to those in controls, and it correlated with SBP (r = 0.328; P<0.05). The results presented show that increased oxidative protein damage is present in all grades of EH. In mild hypertension extracellular antioxidant enzyme activities are not decreased, suggesting they are probably not critical in early EH, but could be important in moderate to severe EH.     

Creatine Kinase as Predictor of Blood Pressure and Hypertension. Is It All About Body Mass Index? A Follow‐Up Study of 250 Patients

The correlation between creatine kinase (CK) and blood pressure (BP) was examined prospectively in 120 patients with persistent high CK and 130 individuals with normal CK. Hypertension was defined as systolic BP (SBP) ≥140 mm Hg or diastolic BP (DBP) ≥90 mm Hg or current use of antihypertensive medication. Baseline CK was weakly correlated with SBP (r=0.11, P=.07) and DBP (r=0.16, P=.01) at follow‐up. Persons with persistent high CK had higher SBP (140.8 mm Hg vs 138.2 mm Hg) and DBP (83.2 mm Hg vs 81.0 mm Hg, P=.06) values and were more likely to have hypertension (66.7% vs 55.5%, P=.05) than individuals with normal CK. In age‐ and sex‐adjusted analysis, a 1‐unit change in logCK was associated with a 4.9‐mm Hg higher SBP, a 3.3‐mm Hg higher DBP, and a 2.2‐higher odds for having hypertension at follow‐up (P=.1, .07, and .06, respectively). When including body mass index (BMI) to the model, BMI was a strong and independent predictor for SBP, DBP, and hypertension at follow‐up and the CK effect on blood pressure was substantially attenuated. This study showed that the CK effect on blood pressure is clearly modified by BMI.     

Endogenous Digoxin-like Immunoactivity in Subjects With Diabetes Mellitus and Hypertension

The serum concentrations of digoxin-like immunoactivity (DLIA) were measured in 99 patients: 20 healthy volunteers (HV), 15 patients with insulin-dependent diabetes mellitus (IDDM), 14 patients with non–insulin-dependent diabetes mellitus without hypertension taking oral hypoglycemic (OHA) agents (NIDDM/−HT), 11 patients with NIDDM without hypertension taking insulin (NIDDM/−HT+INS), 12 NIDDM patients with hypertension taking OHA (NIDDM/+HT), nine NIDDM patients with hypertension taking insulin (NIDDM/+HT/+INS), 10 patients with essential hypertension with normal insulin levels (HT/−HI), and in eight patients with essential hypertension with hyperinsulinemia (HT/+HI). The numbers (%) of subjects with DLIA levels above the detection limit of the assay used (> 0.1 nmol/L) were, in the NIDDM/−HT group, 12/14 (85.7%) and in the NIDDM/+HT group, 9/12 (75%), significantly higher (P < .05) than in the HV (7/20; 35%), IDDM (3/15; 20%), and HT/−HI groups (2/10; 20%). The number and percentage of subjects with DLIA levels above the detection limit in the HT/+HI group was six of eight (75%), significantly (P < .05) higher than in the IDDM and HT/−HI groups, and tended to be higher than in the HV group (P < .055). Means and SD of serum DLIA levels (nmol/L) in the NIDDM/−EH (0.18/0.09) and NIDDM/+EH (0.19/0.15) groups were significantly higher (P < .05) than in the HV (0.09/0.07), IDDM (0.05/0.05), and EH/−HI (0.06/0.06) groups. DLIA levels in the HT/+HI group (0.15/0.12) were significantly higher (P < .05) than in the IDDM and HT/−HI groups. The percentage of DLIA levels above the detection limit, as well as the mean and SD of DLIA in the NIDDM group taking OHA, did not differ from those in subjects taking insulin. In all subjects studied (n = 99), DLIA correlated with C-peptide (r = 0.30; P < .01) and glomerular filtration (GF) (r =− 0.21; P < .05). After exclusion of insulin-treated patients, DLIA correlated significantly with plasma glucose (PG; r = 0.25; P < .05), immunoreactive insulin (IRI; r = 0.41; P < .001), C-peptide (r = 0.27; P < .05), and GF (r =− 0.26; P < .05) (n = 64). Correlation of DLIA with IRI (r = 0.33; P < .05; n = 38) also persisted after exclusion of patients taking insulin and those with DLIA levels below the detection limit. Similarly, DLIA also correlated with C-peptide (r = 0.64; P < .05) and IRI (r = 0.70; P < .05) in the subgroup of 10 patients with the highest levels of DLIA (> 0.25 nmol/L). None of the sera (n = 15) with different DLIA concentrations (0.0–0.38 nmol/L) exhibited K-pNPPase (Na⁺-K⁺-ATPase) inhibitory activity. In conclusion, this work demonstrated elevated serum DLIA in NIDDM and HT/+HI patients, and its correlation with IRI and GF. However, due to the fact that the chemical nature and biologic properties of DLIA are still a matter of debate, it is too early to speculate whether the elevation of DLIA is just a secondary result associated with HI and reduced GF, or whether it also has pathophysiologic consequences. Nevertheless, in both cases the elevated concentrations of substances with DLIA and their interference with antidigoxin antibodies may affect therapeutic monitoring of digitalization in NIDDM and HT/+HI patients. Also, the elevated DLIA could subclassify these patients. The significance of such subclassifications (pathophysiologic, therapeutic, or prognostic), however, will need further investigation.     

Characteristics of young-onset hypertension identified by targeted screening performed at a university health check-up.

Since the prevalence and clinical characteristics of young-onset hypertension are still to be elucidated, we performed targeted-screening at an annual university health check-up for two consecutive years. Out of 16,464 subjects in 2003 and 17,032 in 2004 that were aged less than 30 years, 22 and 26 students (all males) exhibited high blood pressure (BP), respectively, on three occasions during casual BP measurements at the Tohoku University Health Center (systolic and diastolic BP of 140 and/or 90 mmHg or greater, respectively). These students were asked to measure their BP at home, and 9 subjects in total were diagnosed as having essential hypertension (EH). The remaining students were diagnosed as having white coat hypertension (WCH). In 8 out of 9 EH students, their father and/or mother had also been treated with antihypertensive medication. Adjustment by attendance ratio for each BP measurement suggested that the incidence of EH was around 0.1% and that of hypertension (EH and WCH) was around 0.5% in university students aged less than 25 years, since most of the subjects and hypertensive students were between 18 and 24 years old. Body mass index of the EH, which was more than 25 kg/m2 (overweight), was significantly higher than that with WCH. In conclusion, the combination of repeated casual BP measurements and home BP effectively identified young-onset EH. The clinical parameters indicated that male gender, genetic background, and excessive weight were risk factors for young-onset hypertension.     

Left ventricular cardiac geometry and ambulatory blood pressure in children

Limited information is available regarding the relationship between ambulatory blood pressure monitoring (ABPM) and cardiac geometry in hypertensive children. ABPM and 2D‐echocardiography were retrospectively reviewed in children and adolescents <21 years old with primary hypertension. A total of 119 participants (median age 15.0 [IQR 12, 16] years) with hypertension were included. Left ventricular hypertrophy was diagnosed in 39.5% of participants. Normal geometry was found in 47.1%, concentric remodeling (CR) in 13.4%, concentric hypertrophy (CH) in 15.1%, and eccentric hypertrophy (EH) in 24.4% of children. After adjustment for age, sex, and body mass index z‐score, awake systolic blood pressure (BP) index (BPi) (OR 1.07, 95% CI: 1.001‐1.14, P = 0.045), awake diastolic BPi (OR 1.04, 95% CI: 1.00‐1.09, P = 0.048), awake systolic BP load (OR 1.02, 95% CI: 1.000‐1.04, P = 0.047), and sleep systolic BP load (OR 1.02, 95% CI: 1.001‐1.04, P = 0.03) were directly associated with CH. No ABPM parameters were significant predictors of EH. In conclusion, ABPM parameters were found to be independent predictors of cardiac geometry, specifically CH.     

Association of Capillary Density and Function Measures With Blood Pressure,Fasting Plasma Glucose,and Insulin Sensitivity

J Clin Hypertens (Greenwich). 2010;12:125–135. ^©2009 Wiley Periodicals, Inc. The pathophysiology underlying the association between hypertension and insulin resistance remains unclear. The study purpose was to determine whether reduced capillary density and/or function underlie, and may therefore explain, this association. The study was conducted on 115 black and non-black participants aged 18 to 55 years: 91 with normal blood pressure (systolic blood pressure [SBP] <130 mm Hg) and 24 with mild blood pressure elevation (SBP 130–159 mm Hg). Capillary density and function were quantified using direct capillaroscopy measures. Insulin sensitivity (IS) was estimated using the Quantitative Insulin Sensitivity Check Index (QUICKI). Endothelial function (EF) was measured using strain-gauge plethysmography. Data were analyzed by linear regression adjusted for age, sex, race, and body mass index (BMI). After adjustment for BMI, capillary density and function measures were significant predictors of SBP ( P<.01), fasting plasma glucose (P=.012, P=.03, and P=.004, respectively), and EF (P=.033, P=.001, and P=.009, respectively). However, none of the capillary measures were significant predictors of fasting insulin or IS. These capillaroscopy data demonstrated an association with SBP but not insulin resistance, suggesting that capillary measures are unlikely to explain the association between hypertension and insulin resistance, at least with modest degrees of blood pressure elevation.     

Determinants of the White‐Coat Effect in Normotensives and Never‐Treated Mild Hypertensives

The prognostic significance of the white‐coat effect (WCE) is unclear. Knowledge of the predictors of the WCE may help illuminate the clinical significance of this phenomenon. The purpose of this study was to (i) compare characteristics of subjects demonstrating a WCE, those not demonstrating a WCE, and those demonstrating a reverse WCE and (ii) determine clinical features that may influence the size of the WCE. Forty‐one subjects with normotension or mild hypertension who had never been treated with antihypertensive medications were recruited for the study. All subjects underwent a battery of anthropometrical measurements and clinic blood pressure (BP) measurements. To calculate arterial compliance, impedance cardiography was used to measure resting stroke volume in each subject. All subjects performed a laboratory mental stress protocol to determine the size of the BP reactivity. Ambulatory blood pressure (ABP) profiles were studied in each subject with the use of an oscillometric ABP recorder. White‐coat effect was determined by subtracting the awake period of the ambulatory systolic blood pressure (SBP) from the clinical SBP. Subjects were grouped according to the size of their WCE. Those who showed a WCE of 5 mmHg and above were assigned to the WCE group; those who showed a WCE of between ?5 and 5 mmHg were assigned to the no white coat effect (NWCE) group; those who exhibited a WCE of ?5 mmHg and lower were assigned to the reverse white‐coat effect (RWCE) group. Subjects with a positive WCE had significantly higher body mass index (BMI) than those without a WCE and those with a RWCE. The WCE group had significantly higher clinic SBP and heart rate (HR) than the RWCE group. Arterial compliance was significantly lower in the WCE group as compared to the NWCE group and the RWCE group. The three groups had comparable ABP profiles. In terms of BP variability, the increase in SBP in response to mental stress did not differ among the three study groups nor did the 24‐hour and awake BP variability. For the sample as a whole, clinic HR and clinic‐ambulatory SBP difference were higher and arterial compliance were lower in women than in men. Furthermore, clinic SBP significantly correlated with the systolic WCE (r = 0.40, P = 0.009). When men and women were analyzed separately, the correlation between clinic SBP and the systolic WCE was significant in women (r = 0.63, P = 0.001) but not in men (P = 0.95). Multiple linear regression showed that sex (P = 0.013) and clinical SBP (P = 0.003) were the only two variables that significantly influenced the systolic WCE. These two variables together accounted for 29% of the variation in the systolic WCE. In conclusion sex and clinic BP are two major determinants of the WCE. The results of this study indicate that WCE is not related to higher stress reactivity or higher BP variability.