White fish reduces cardiovascular risk factors in patients with metabolic syndrome: the WISH-CARE study, a multicenter randomized clinical trial.

BACKGROUND AND AIMS: Reduction of cardiovascular risk with high consumption of fish in diet is still a matter of debate, and concerns about heavy metal contamination have limited consumption of oily fish. We aimed to evaluate the effect of regular ingestion of white fish on cardiovascular risk factors in patients with metabolic syndrome. METHODS AND RESULTS: Multicenter randomized crossover clinical trial including 273 individuals with metabolic syndrome. An 8-week only-one dietary intervention: 100 g/d of white fish (Namibia hake) with advice on a healthy diet, compared with no fish or seafood with advice on a healthy diet. Outcomes were lipid profile, individual components of the metabolic syndrome, serum insulin concentrations, homeostasis model of insulin resistance, serum C-reactive protein and serum fatty acid levels. We found a significant lowering effect of the intervention with white fish on waist circumference (P < 0.001) and diastolic blood pressure (P = 0.014). A significant lowering effect was also shown after the dietary intervention with fish on serum LDL concentrations (P = 0.048), whereas no significant effects were found on serum HDL or triglyceride concentrations. A significant rise (P < 0.001) in serum EPA and DHA fatty acids was observed following white fish consumption. Overall adherence to the intervention was good and no adverse events were found. CONCLUSION: In individuals with metabolic syndrome, regular consumption of hake reduces LDL cholesterol concentrations, waist circumference and blood pressure components of the metabolic syndrome. CLINICAL TRIAL REGISTRY: White Fish for Cardiovascular Risk Factors in Patients with Metabolic Syndrome Study, Registered under ClinicalTrials.gov Identifier: NCT01758601.

[Prevalence of binge eating disorder among a clinical sample of obese children]. / Prevalencia del trastorno por atracón en una muestra clínica de obesos.

INTRODUCTION: Binge eating disorder is characterised by the presence of recurrent binge eating episodes in a short period of time, accompanied by loss of control. This disorder is the most frequent of all eating disorders in obese people, both adults and children. OBJECTIVE: The objective of this study was to obtain prevalence data for binge eating disorder in a sample of obese children who attended a paediatric unit specialised in the treatment of childhood obesity. MATERIAL AND METHODS: A sample included 70 children and adolescents aged 9 to 16, with a mean age of 12 years attending a paediatric clinic in the General Hospital of Valencia. The following tools were used in the assessment: Diagnostic Interview for Binge Eating Disorder (SCID-IV), Binge Eating Disorder Scale Child (C-BED) and Questionnaire of eating patterns and weight (QEWP). RESULTS: After the assessment, 6% of the clinical sample was diagnosed with binge eating disorder according to criteria established by the DSM-IV-TR, and 14% showed subclinical forms of the disorder. CONCLUSIONS: The results are in line with previous studies that highlight the necessity of assessing these disorders in units specialised in the treatment of obesity.

[Management of high blood pressure in children and adolescents: Recommendations of the European Society of hypertension]. / Manejo de la hipertensión arterial en niños y adolescentes: recomendaciones de la Sociedad Europea de Hipertensión.

Hypertension in children and adolescents has been gaining ground in cardiovascular medicine, mainly due to the advances made in several areas of pathophysiological and clinical research. These guidelines arose from the consensus reached by specialists in the detection and control of hypertension in children and adolescents. Furthermore, these guidelines are a compendium of scientific data and the extensive clinical experience it contains represents the most complete information that doctors, nurses and families should take into account when making decisions. These guidelines, which stress the importance of hypertension in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, should act as a stimulus for governments to develop a global effort for the early detection and suitable treatment of high pressure in children and adolescents. J Hypertens 27:1719-1742 Q 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

European Society of Hypertension practice guidelines for home blood pressure monitoring.

Self-monitoring of blood pressure by patients at home (home blood pressure monitoring (HBPM)) is being increasingly used in many countries and is well accepted by hypertensive patients. Current hypertension guidelines have endorsed the use of HBPM in clinical practice as a useful adjunct to conventional office measurements. Recently, a detailed consensus document on HBPM was published by the European Society of Hypertension Working Group on Blood Pressure Monitoring. However, in daily practice, briefer documents summarizing the essential recommendations are needed. It is also accepted that the successful implementation of clinical guidelines in routine patient care is dependent on their acceptance by involvement of practising physicians. The present document, which provides concise and updated guidelines on the use of HBPM for practising physicians, was therefore prepared by including the comments and feedback of general practitioners.

[Drugs used in paediatric outpatients: do we have enough information available?]. / Medicamentos utilizados en pediatría extrahospitalaria: disponemos de información suficiente?

OBJECTIVE: To analyse the drugs taken in paediatric outpatients and the information available on these drugs. PATIENTS AND METHODS: A cross-sectional, observational, descriptive study was carried out. The study involved a sample of children under 14 years seen in the Emergency Room of the HGUV from June 2005 to August 2006. The medicines they received were quantified and classified, and the information on these drugs available in the Vademecum International Medicom and in the Summary of Product Characteristics, were analysed. RESULTS: Of the 462 children (mean age 5.2 (95 % CI 4.9-5.6)) included, 336 received 667 medicines (152 different medicines) that contained 864 drugs (161 different drugs). In 34.3 % of the cases it was for self-medication. Children under 4 years received more drugs than the older group (80.2 % in the younger group and 67.4 % in the older). Patients received from 1 to 7 medicines (mean 2.0). Children receiving 2 or 3 medicines were younger than those who received one. Five therapeutic groups of the Anatomical-Therapeutical-Chemical Classification (ATC) include the 93.1 % of the drugs administered (R: 26.5 %; M: 23.8 %; N: 22.8 %; J: 10.6 % and A: 10.0 %). In the information sources consulted there was no information available on paediatric use for 40 of the 152 medicines used. CONCLUSIONS: Almost 75 % of patients seen in the Emergency Room were already receiving drugs before they arrived at the hospital, in many cases as a result of self-medication. The information available on the paediatric use of drugs is deficient. Clinical research is required to study the effects of pharmacological treatment on children and to improve the information on their use.

Obesity, body fat distribution, and ambulatory blood pressure in children and adolescents.

Obesity is a common disease with an ever-increasing prevalence and usually with late-onset consequences. If acquired during childhood, it tracks into adult life to some extent, and since the relationship between obesity and hypertension is well established in adults, obese children appear to be at particularly high risk of becoming hypertensive adults. In the authors' study, obese children seemed to have significantly higher casual and ambulatory blood pressure than nonobese children, except for nighttime diastolic blood pressure. The health effects of obesity may depend on the anatomic distribution of body fat, which in turn may be a better indicator of endocrinologic imbalance, environmental stress, or genetic factors than is fatness per se. Subjects with a higher waist-to-hip ratio or a larger waist, as an estimate of central obesity, tend to have higher blood pressure values even during childhood. Prevention of the onset of obesity in early life may be important to reducing the risk of coronary heart disease in later life.

Birth weight influences blood pressure values and variability in children and adolescents.

The objective of the present study was to assess the relationships between birth weight and the values and variability of ambulatory blood pressure. Six hundred thirty healthy children (369 girls) age 4 to 18 years (mean, 9.9 years) born at term after a normotensive pregnancy were included. The subjects were divided into 5 groups according to birth weight. For each subject, a 24-hour ambulatory blood pressure monitoring was performed according to the protocol designed. Average and variability (estimated as the standard deviation) of ambulatory blood pressure and heart rate were calculated separately for 24-hour, daytime, and nighttime periods. When values were adjusted for gender, current age, weight, and height, children with the lowest birth weights had the highest ambulatory blood pressure values and variability, whereas no differences in heart rate were observed. Multiple regression analysis showed that although current weight was the strongest predictor for 24-hour systolic blood pressure (P<0.001), there was also an independent and significant inverse relationship for birth weight (P<0.002) after controlling for gender, current age, and height. Likewise, birth weight was independently and inversely correlated with 24-hour systolic blood pressure variability (P<0.03). In conclusion, children who had lower birth weights tended to have not only the highest blood pressure values but also the highest blood pressure variability, independent of the increases in ambulatory blood pressure values. Knowing that high blood pressure variability is at least partially independent of blood pressure values, the importance of this variability on further blood pressure rises and/or on vascular damage later in life needs to be assessed in future studies.

The spectrum of circadian blood pressure changes in type I diabetic patients.

BACKGROUND: The objective of the present study was to characterize the spectrum of circadian blood pressure changes in type I diabetes at different stages of nephropathy by using two monitorings in each patient in order to avoid intra-individual variability. PATIENTS AND METHODS: A total of 80 type I diabetic subjects and the same number of age, sex and awake mean blood pressure (BP)-matched controls were included. According to urinary albumin excretion, there were 57 normoalbuminurics, 15 persistent microalbuminurics and eight proteinurics. Two 24 h ambulatory blood pressure monitorings were performed at the same urinary albumin excretion stage in absence of antihypertensive treatment for each diabetic subject and for their respective control. Blood pressure and heart rate averages during 24 h, awake, sleep, and day: night ratio were calculated. RESULTS: Seven of the eight proteinuric subjects were hypertensives, whereas hypertension was absent in the normoalbuminuric and microalbuminuric groups. The intraindividual reproducibility in diabetics showed repeatability coefficients for the 24 h systolic and diastolic pressure of 33 and 42%, respectively. This reproducibility for the day: night ratio was generally worse, 57% for systolic and 59% for diastolic. A progressive increment in the mean ambulatory BP was observed across the three groups of diabetics and the differences in BP observed were most evident during the night-time period. Though no differences in the 24 h circadian pattern were present between the normoalbuminurics and their controls, nocturnal differences were observed, not only in microalbuminurics for systolic BP (P < 0.05), but also in proteinurics for both systolic BP (P < 0.01) as well as diastolic BP (P < 0.05). No differences were observed in heart rate among the diabetic groups. The non-dipping pattern in the two monitorings was observed in 80, 58, 18 and 10% of the proteinurics, microalbuminurics, normoalbuminurics and control groups, respectively. CONCLUSIONS: Persistent abnormal circadian variability seems to be an early and frequent characteristic of type I diabetics with an increased urinary albumin excretion. Although present in some normalbuminuric subjects, the frequency of this abnormality increases as the incipient nephropathy progresses. By the time proteinuria is established, nearly all subjects present the abnormal pattern.

Overview of ambulatory blood pressure monitoring in childhood and pregnancy.

Despite the fact that the study and applicability of ambulatory blood pressure in children and pregnant women share characteristics which limit the potential development of knowledge for their use, advances produced in the last few years provided the present knowledge regarding the significance and the potential use of ambulatory blood pressure in children and in the pregnant women. In children ambulatory blood pressure monitoring is useful for the diagnosis of mild hypertensives, assessment of refractory hypertension, therapeutic trials with antihypertensive drugs, and clinical investigation when BP is one of the parameters to be taken into account and/or when subtle BP abnormalities are the objective of the study. In pregnant women, the main applicability is to assess the maternal and fetal risk in the hypertensive disorders of pregnancy.

Obesity modifies the relationship between ambulatory blood pressure and natriuresis in children.

BACKGROUND: The objective in the present study was to evaluate if obesity beginning in the first two decades of life influences the relationship between ambulatory blood pressure and urinary sodium excretion. DESIGN AND METHODS: Eighty-five obese and 88 non-obese children aged 3-19 years were included in the study. For each subject, a 24h ambulatory blood pressure monitoring and a complete urine collection were simultaneously performed according to the protocols designed. The averages of ambulatory blood pressure and of the urinary excretion rates for sodium, potassium and creatinine were calculated separately for 24-h, awake and sleep periods as defined by a mini-diary. RESULTS: Weight and sodium excretion are directly associated with systolic blood pressure; however, the relationship between blood pressure and sodium excretion seems to be modified in obese children as compared to controls. The interaction between sodium excretion and weight was negative indicating that the rate of change of systolic blood pressure by sodium unit is smaller for the obese than for the non-obese, even though at the same urinary sodium excretion level the obese children had higher ambulatory systolic blood pressure. CONCLUSIONS: Obesity during the first two decades of life seems to restrict sodium excretion, leading to higher blood pressure values. The capacity to excrete sodium seems to be heterogeneous, the lowest capacity being at the highest blood pressure values. Subsets of the obese, those with the lowest ability to excrete sodium, may be further protected by low sodium intake in order to prevent a rise in blood pressure.

[Remediable glucocorticoid hyperaldosteronism: molecular diagnosis]. / Hiperaldosteronismo remediable con glucocorticoides: diagnóstico genético.

BACKGROUND: The first family diagnosed in Spain of glucocorticoid remediable aldosteronism (GRA) is reported. SUBJECTS AND METHODS: We described the phenotype, biochemical values and genetic diagnosis of a GRA pedigree. DNA analysis was performed by using Southern-blot and polymerase chain reaction. RESULTS: We reported a 14-year-old boy who presented with severe hypertension, and strong family history of early-onset hypertension. His suppressed plasmatic renin activity, family history and failure to respond to conventional antihypertensive therapy raised GRA as a potential etiology. The diagnosis was confirmed by genetic testing, in the index case and in one of family members, which demonstrated the chimeric gene duplication, which was a resultant of a crossing-over between the proximal portion of 11 beta-hydroxylase gen, CYP11B1, and the distal portion of aldosterone synthetase gene CYP11B2. Two other family members, who died, suffered hyporeninemic severe hypertension. The cause of death in one of them was hemorrhagic stroke. Amiloride, which blocks sodium transport in the distal nephron, plus hydroclorothiazide was an effective treatment option. CONCLUSIONS: The role of molecular diagnosis techniques is essential for the rapid diagnosis of cases of arterial hypertension secondary to familial glucocorticoid remediable aldosteronism.

Factors related to quality of ambulatory blood pressure monitoring in a pediatric population.

To assess the factors related to the quality of ambulatory blood pressure monitoring in a pediatric population, we performed 24-h ambulatory blood pressure monitorings on 333 unselected children aged 3 to 18 years using a Spacelabs 90207 monitor. For each individual, the percentages of valid measurements (ratio between valid and total number of measurements, 76.4% +/-15.6%) and of successful measurements (percentage of valid preset measurements, 89.8% +/- 11.5%) were calculated. Two hundred eighty-one (84.1%) monitorings had a successful measurement rate of >80%. Two hundred thirteen (64%) were of excellent quality, as defined by the percentage of successful measurements being higher than or equal to 90%. Age (P < .0001) and 24-h systolic blood pressure (P < .04) were positively and independently associated (in multiple regression analysis) to the percentage of successful measurements, accounting for 8% of the variance. Furthermore, a significant negative correlation between causal pulse pressure and the number of erroneous measurements was observed (r = -0.18, P < .01). This study has shown that in a pediatric population, the quality of the monitoring depends only in part on age and ambulatory systolic blood pressure values when an oscillometric device is used. The results have demonstrated the important role pulse pressure amplitude plays when accounting for the number of erroneous measurements.

[Circadian rhythms variability of arterial pressure: methodological aspects for the measurement]. / Variabilidad circadiana de la presión arterial: aspectos metodológicos para su estimación.

BACKGROUND: To study the differences among the methods used for estimating daytime and nighttime ambulatory blood pressure values, and to analyze their determinant factors. SUBJECTS AND METHODS: In 402 individuals mean values of systolic and diastolic blood pressure (SBP and DBP) during 24 h, daytime and nighttime, were calculated by three different methods: a) real-time, following a minidiary; b) long-time, having a nighttime period from 23:00 to 07:00 h, and a daytime one from 08:00 to 22:00 h, and c) short-time, having a nighttime period from midnight to 6:00 h, and a daytime one from 08:00 to 22:00 h. RESULTS: Daytime mean values of SBP and DBP were similar for the three methods. Nighttime mean values of SBP and DBP calculated using the long-time were significantly higher than those calculated with the real-time ((SBP -2.25 [5.3] mmHg, p < 0.05; DBP -1.17 [3.4] mmHg, p < 0.05). No differences were observed for both SBP and DBP with the real-time. The number of sleeping hours was the main determinant of the differences observed between the long-time and the real-time methods. The percentage of subjects with a non-dipping pattern were 17, 26 and 18% for real, long and short time methods, respectively. CONCLUSIONS: Daytime mean BP values are reproducible whatever the method used, but for estimating nighttime mean BP values short-time is the best of the fixed-time methods. Minidiary should be used if more accurate values are necessary or if the subjects sleep habits do not fit into the standard patterns.