Portal de Periódicos da CAPES

Adult cardiovascular risk factors in premature babies

2000; Elsevier BV; Volume: 356; Issue: 9233 Linguagem: Inglês

10.1016/s0140-6736(05)73920-9

1474-547X

Miklós Szathmári, Barna Vásárhelyi, György Reusz, Tivadar Tulassay,

Child and Adolescent Health

R John Irving and colleagues1Irving RJ Belton NR Elton RA Walker BR Adult cardiovascular risk factors in premature babies.Lancet. 2000; 355: 2135-2136Summary Full Text Full Text PDF PubMed Scopus (226) Google Scholar conclude that low birthweight alone is a risk factor for raised blood pressure, and that babies small for gestational age are not more dis advantaged at age 24 years than those with birthweight appropriate for gestational age.We have tried to find out whether the there is an effect of IUGR and prematurity on blood pressure and heart rate in young adults. Moreover, since evidence suggests the presence of raised basal cortisol concentrations in low birthweight people of both sexes2Phillips DI Walker BL Reynolds RM et al.Low birth weight predicts elevated plasma cortisol concentrations in adults from 3 populations.Hypertension. 2000; 35: 1301-1306Crossref PubMed Scopus (344) Google Scholar and higher dehydroepiandrosterone (DHEA) concentrations in low birthweight girls,3Ibanez L Potau N Marcos MV de Zegher F Exaggerated adrenarche and hyperinsulinism in adolescent girls born small for gestational age.J Clin Endocrinol Metab. 1999; 84: 4739-4741Crossref PubMed Google Scholar we investigated the association of these hormone concentrations with blood pressure.We enrolled adults aged 19–21 years, 32 who had been small for gestational age and 38 appropriate for gestational age, and 30 controls. Birthweight of controls was normal (3250 g [SD 298]) and in the other two groups was less than 2500 g (small 1749 [315], appropriate 1861 [342]). Medical history and laboratory data showed that all participants were apparently healthy and none was taking medications (including oral contraceptives). Current bodyweight and height was similar for all three groups.Blood was taken at 0800 h after an overnight fast. Serum cortisol and DHEA were measured with radioimmunoassay. We measured ambulatory systolic and diastolic blood pressure and heart rate over 4 h, every 20 min, to get mean values. Data were analysed by ANOVA and multiple linear regression adjusted for current bodymass index.The table shows the results. Cortisol was associated with high systolic blood pressure (r=0·40, p<0·01) and heart rate (r=0·41, p<0·01) in men but not in women. DHEA was associated with high systolic blood pressure (r=0·35, p<0·05) and heart rate (r=0·49, p<0·01) in women, but not in men.TableMean (SD) valuesControlSGAAGAWomen (n=14)Men n=16)Total (n=30)Women (n=15)Men (n=17)Total (n=32)Women (n=18)Men (n=20)Total (n=38)Heart rate (beats per min)79 (7)72 (8)75 (8)86 (14)81 (11)*p<0·05 vs control.†p<0·05 AGA vs SGA. SGA=small for gestational age; AGA=appropriate for gestational age; BP=blood pressure.83 (12)*p<0·05 vs control.84 (11)74 (7)79 (9)Diastolic BP (mm Hg)74 (10)70 (7)72 (8)79 (10)76 (6)*p<0·05 vs control.77 (8)*p<0·05 vs control.80 (8)73 (5)76 (6)Systolic BP (mm Hg)120 (10)125 (7)123 (9)126 (15)131 (9)128 (12)132 (9)*p<0·05 vs control.130 (11)131 (10)*p<0·05 vs control.Basal cortisol concentration (mol/L)0·20 (0·07)0·22 (0·06)0·21 (0·06)0·29 (0·08)*p<0·05 vs control.†p<0·05 AGA vs SGA. SGA=small for gestational age; AGA=appropriate for gestational age; BP=blood pressure.0·29 (0·07)*p<0·05 vs control.0·29 (0·07)*p<0·05 vs control.0·23 (0·06)0·26 (0·07)0·25 (0·06)*p<0·05 vs control.DHEA (nmol/L)23·6 (8·7)29·2 (7·4)36·1 (12·8)*p<0·05 vs control.29·3 (10·2)30·3 (13·3)29·0 (9·3)SGA=small for gestational age; AGA=appropriate for gestational age; BP=blood pressure.* p<0·05 vs control.† p<0·05 AGA vs SGA. SGA=small for gestational age; AGA=appropriate for gestational age; BP=blood pressure. Open table in a new tab Our results lend support to Irving and colleagues' findings. Low birthweight seems to be a risk factor for hypertension, independent of its origin. Moreover, by contrast with Irving and colleagues' method we measured the blood pressure with ambulatory blood pressure monitoring to exclude the possible bias caused by the stress of blood-pressure measurement, which seems to be especially important because of raised basal cortisol concentrations.The mechanism of the raising of blood pressure is probably different in low-birthweight men and women. Raised cortisol concentrations might be a link between low birthweight and high blood pressure in young adults.4Benediktsson R Lindsay RS Noble J Seckl JR Edwards CRW Glucocorticoid exposure in utero: new model for adult hypertension.Lancet. 1993; 341: 339-341Summary PubMed Scopus (764) Google Scholar Our data suggest, that by contrast with low-birthweight men, the presence of adrenal hyperandrogenism might play a part in raising blood pressure in low-birthweight women.5Johannes CB Stellate RK Feldman HA Longcope C McKinlay JB Relation of dehydroepiandrosterone and dehydroepiandrosterone sulfate with cardiovascular disease risk factors in women: longitudinal results from Massachusetts women's health study.J Clin Epidemiol. 1999; 52: 95-103Summary Full Text Full Text PDF PubMed Scopus (73) Google ScholarThis study was supported by ETT 484/96, ETT 556/96, and OTKA Grant T031850-F032024. R John Irving and colleagues1Irving RJ Belton NR Elton RA Walker BR Adult cardiovascular risk factors in premature babies.Lancet. 2000; 355: 2135-2136Summary Full Text Full Text PDF PubMed Scopus (226) Google Scholar conclude that low birthweight alone is a risk factor for raised blood pressure, and that babies small for gestational age are not more dis advantaged at age 24 years than those with birthweight appropriate for gestational age. We have tried to find out whether the there is an effect of IUGR and prematurity on blood pressure and heart rate in young adults. Moreover, since evidence suggests the presence of raised basal cortisol concentrations in low birthweight people of both sexes2Phillips DI Walker BL Reynolds RM et al.Low birth weight predicts elevated plasma cortisol concentrations in adults from 3 populations.Hypertension. 2000; 35: 1301-1306Crossref PubMed Scopus (344) Google Scholar and higher dehydroepiandrosterone (DHEA) concentrations in low birthweight girls,3Ibanez L Potau N Marcos MV de Zegher F Exaggerated adrenarche and hyperinsulinism in adolescent girls born small for gestational age.J Clin Endocrinol Metab. 1999; 84: 4739-4741Crossref PubMed Google Scholar we investigated the association of these hormone concentrations with blood pressure. We enrolled adults aged 19–21 years, 32 who had been small for gestational age and 38 appropriate for gestational age, and 30 controls. Birthweight of controls was normal (3250 g [SD 298]) and in the other two groups was less than 2500 g (small 1749 [315], appropriate 1861 [342]). Medical history and laboratory data showed that all participants were apparently healthy and none was taking medications (including oral contraceptives). Current bodyweight and height was similar for all three groups. Blood was taken at 0800 h after an overnight fast. Serum cortisol and DHEA were measured with radioimmunoassay. We measured ambulatory systolic and diastolic blood pressure and heart rate over 4 h, every 20 min, to get mean values. Data were analysed by ANOVA and multiple linear regression adjusted for current bodymass index. The table shows the results. Cortisol was associated with high systolic blood pressure (r=0·40, p<0·01) and heart rate (r=0·41, p<0·01) in men but not in women. DHEA was associated with high systolic blood pressure (r=0·35, p<0·05) and heart rate (r=0·49, p<0·01) in women, but not in men. SGA=small for gestational age; AGA=appropriate for gestational age; BP=blood pressure. Our results lend support to Irving and colleagues' findings. Low birthweight seems to be a risk factor for hypertension, independent of its origin. Moreover, by contrast with Irving and colleagues' method we measured the blood pressure with ambulatory blood pressure monitoring to exclude the possible bias caused by the stress of blood-pressure measurement, which seems to be especially important because of raised basal cortisol concentrations. The mechanism of the raising of blood pressure is probably different in low-birthweight men and women. Raised cortisol concentrations might be a link between low birthweight and high blood pressure in young adults.4Benediktsson R Lindsay RS Noble J Seckl JR Edwards CRW Glucocorticoid exposure in utero: new model for adult hypertension.Lancet. 1993; 341: 339-341Summary PubMed Scopus (764) Google Scholar Our data suggest, that by contrast with low-birthweight men, the presence of adrenal hyperandrogenism might play a part in raising blood pressure in low-birthweight women.5Johannes CB Stellate RK Feldman HA Longcope C McKinlay JB Relation of dehydroepiandrosterone and dehydroepiandrosterone sulfate with cardiovascular disease risk factors in women: longitudinal results from Massachusetts women's health study.J Clin Epidemiol. 1999; 52: 95-103Summary Full Text Full Text PDF PubMed Scopus (73) Google Scholar This study was supported by ETT 484/96, ETT 556/96, and OTKA Grant T031850-F032024.