Markers of metabolic syndrome and insulin resistance as main predictors of target-organ changes in children with primary hypertension
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The aim of this study was to determine the prevalence of metabolic abnormalities and of metabolic syndrome and its relationship to subclinical target-organ damage in 113 children with untreated primary hypertension (PH; mean age 15 yrs (range 4-18 yrs)) and 134 healthy control children. To this end, anthropometric and biochemical cardiovascular risk factors, HOMA-IR, insulin sensitivity index (ISI[0, 120]), and serum adiponectin were assessed. Metabolic syndrome as defined by classic criteria was diagnosed in 20.4% of children with PH and in 3% of controls, but when PH was not taken as a criterion, metabolic syndrome was present in 6.2% of patients (no significance). Left-ventricular hypertrophy (LVH) was found in 40.7% and severe LVH in 12.5% of patients. Patients with LVH had a greater BMI, greater waist-to-hip ratio, and a greater number of parameters of the metabolic syndrome (overall P<0.05). Both carotid (cIMT) and femoral superficial arterial intima-media thickness correlated positively with HOMA-IR and negatively with ISI[0,120] and serum adiponectin (P<0.05). The main predictor for cIMT was adiponectin (P=0.002) whereas the main predictors for LVH were BMI-standard deviation score (P=0.04) and HOMA-IR (P=0.04). The authors conclude that the applied markers of metabolic syndrome and insulin resistance were the main predictors of target-organ damage in a non-selected group of children with PH.
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