[Factors of physical development of healthy children in relation to 24-hour ambulatory blood pressure patterns]. / Wskazniki rozwoju fizycznego zdrowych dzieci a wyniki 24-godzinnego pomiaru cisnienia tetniczego.

UNLABELLED: The aim of this study was to assess which of the relationships between ambulatory blood pressure patterns and physical development factors in healthy children was the strongest and most significant. 24-hour ambulatory blood pressure monitoring (ABPM) was performed on 100 healthy children aged 10-18 years. Mean values of diurnal, nocturnal and 24-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated on its basis. Correlation coefficients were calculated for the associations between these mean values and physical development factors: age, body mass, body height, body mass index (BMI) and BMI centile. SBP levels were the strongest and most significant, positively associated with values of BMI, body mass and BMI centile. The correlation with age was weaker and with body height the most weak. DBP levels correlated significantly only with BMI centile and showed relationship of bordering significance with BMI value. There were no significant correlations between DBP levels and age, body mass or body height. CONCLUSIONS: In children BMI and its centile correlate with ambulatory blood pressure levels stronger and more significant than other physical development factors. Three-dimensional centile charts including age, BMI and blood pressure level could be the most accurate in diagnosing hypertension.

Coronary atherosclerosis in patients with acquired valvular disease.

BACKGROUND: Coronary atherosclerosis often coexists with acquired valvular disorders. There is growing evidence in literature that these two conditions may have common aetiology. AIM: To assess the incidence of coronary atherosclerosis in patients with acquired valvular disorders and to compare clinical parameters as well as the prevalence of risk factors between patients with aortic and mitral valve diseases. METHODS: The study group consisted of 155 patients (101 males, 54 females, mean age 58.2+/-9.7 years) with acquired valvular disorder who between 2000 and 2002 underwent invasive cardiac evaluation in our department prior to planned cardiac surgery. Aortic stenosis was detected in 74 patients, aortic insufficiency -- in 26, mitral stenosis -- in 33, and mitral regurgitation -- in 14 subjects. All patients underwent clinical evaluation, echocardiography, coronary angiography and laboratory tests. RESULTS: Patients with aortic stenosis had similar prevalence of coronary atherosclerosis to patients with aortic insufficiency, and patients with mitral stenosis -- to patients with mitral regurgitation. When the two groups -- patients with aortic valve disease and patients with mitral valve disease were compared, significant coronary lesions were more often detected in patients with aortic valve disease (36% vs 12.8%, p<0.05). Also, patients with aortic valve disorder were older, predominantly of male gender, had more often angina but less often heart failure, and had higher total cholesterol level than patients with mitral valve disease. CONCLUSIONS: Significant coronary lesions are more frequently encountered in patients with aortic valve disorder than in those with mitral valve disease. A high prevalence of atherosclerotic risk factors in patients with aortic valve disease may suggest that this condition has similar aetiology to that of coronary artery disease.

Renin-angiotensin system gene polymorphisms: assessment of the risk of coronary heart disease.

BACKGROUND: Renin-angiotensin system genes are candidate genes in cardiovascular system diseases. Angiotensinconverting enzyme (ACE), angiotensinogen (AGT) and angiotensin II type 1 receptor (AT1R) gene polymorphisms are considered risk factors in coronary heart disease (CHD). AIM: To evaluate the involvement of the ACE, AGT and AT1R genetic variants in predisposition to CHD as well as their association with other known risk factors. METHODS: The study included 400 male subjects (200 with CHD and 200 healthy individuals). Genotypes were determined by a polymerase chain reaction (PCR). For the AGT and AT1R genes a restriction analysis of the PCR product was performed. The allele frequency and genotype distribution were compared between groups. RESULTS: The allele and genotype frequencies of the ACE gene were similar in both groups, however, a significantly higher frequency of the DD genotype was observed in the presence of hyperlipidemia (39% vs 24% in non-hyperlipidemic subjects, p<0.01). The AGT gene polymorphism was associated with the development of CHD. The T allele was significantly more frequent in patients than in the control group (55% vs 44%, p<0.05). The heterozygous MT genotype was observed in 61% of patients compared to 40% in the controls (p<0.05). The A1166C polymorphism of the AT1R gene was also associated with CHD as well as with age at the onset of disease. The frequency of the C allele was 29% compared to 21% in the control group (p<0.01) and the frequency of the CC homozygote was almost three times higher in patients. CONCLUSIONS: There is an association between molecular variants of the angiotensinogen and angiotensin II type 1 receptor and increased risk of CHD. The DD genotype of the ACE gene polymorphism and the TT genotype of the AGT gene polymorphism were significantly more frequent in patients with hyperlipidemia. The TT genotype of the AGT gene M235T polymorphism was associated with an increased risk of CHD and myocardial infarction only in smokers.

White coat effect--problem of assessing its incidence and magnitude in children.

The aim of this study was an attempt to assess the incidence and estimate the method of calculating the magnitude of white coat effect (WCE) in healthy children. 59 healthy children aged 10-18 years underwent office blood pressure (BP) measurement and 24-hour ambulatory blood pressure monitoring (ABPM). WCE magnitude was evaluated according to the generally accepted method, as the difference between office BP and mean daytime ambulatory BP value. WCE magnitude calculated in that way was negative in 49 % children, and positive in 51 % children. Systolic blood pressure WCE ranged from (-43.79) to (+44.35) mmHg; the mean value was (+1.60) mmHg. Diastolic blood pressure WCE ranged from (-66.14) mmHg to (+48.00) mm Hg, and the average was (-1.47) mmHg. 1. Positive WCE was observed in about 50 % of the examined children. 2. Mean daytime ambulatory BP level in children may be greater than office BP level. It may be the consequence of a higher level of physical activity in children than in adults. 3. The generally accepted method of calculating WCE magnitude in adults seems inappropriate for children. 4. Introducing a new method of evaluating WCE in children (different from that used in adults) may be worth consideration.