Comparative analysis of lipid and carbohydrate metabolism in adolescents with arterial hypertension and obesity
Objective. To study the specificities of the parameters of lipid and carbohydrate metabolism and insulin resistance in adolescents with arterial hypertension depending on overweight. Patients and methods. We examined 392 adolescents aged 12 to 18 years. The treatment group included 273 patients with primary arterial hypertension who had either normal body weight or obesity, the control group consisted of 119 patients with normal blood pressure levels: 84 overweight or obese and 35 practically healthy teenagers. The study protocol included anthropometric examination, measurement of arterial blood pressure and 24-hour blood pressure monitoring, and also blood biochemistry (lipid spectrum, uric acid, glucose, insulin, cortisol levels). Results. Arterial hypertension on overweight and obese patients is characterised by dyslipidemia with prevalence of high values (>1.47 mmol/l) of hypertriglyceridemia (44.76%), marked (<0.9 mmol/l) decrease of the levels of high density lipoprotein cholesterol (21.68%) and high (>3.0) values of the atherogenic index (53.85%), and also hyperuricemia (72.03%) and impaired carbohydrate metabolism (hyperinsulinemia (18.18%) and insulin resistance (41.96%). At the same time, higher cortisol levels are recorded (182.3 nmol/l) in children with normal body weight, while metabolic changes are less expressed. In patients with normal body weight, moderate (1.0-1.46 mmol/l) hypertriglyceridemia (27.27%), a moderate (0.9-1.2 mmol/l) decrease of high density lipoprotein cholesterol levels (43.75%) and an elevated atherogenic index (>3.0) (12.5%), hyperuricemia (43.75%) are found. Conclusion. The data we obtained are demonstrative of the prevalence of endothelial dysfunction in the pathogenesis of arterial hypertension in overweight and obese adolescents, conditioned by hyperinsulinemia, insulin resistance, hyperuricemia and hypertriglyceridemia. At the same time, arterial hypertension in children with normal body weight is underlain by sympathetic overactivity (cortisol levels) in combination with endothelial dysfunction conditioned by hyperuricemia. The revealed differences in the parameters of fat, carbohydrate and uric acid metabolism in patients of the study groups permit to make a conclusion about the difference between the pathogenetic mechanisms of the development of arterial hypertension in obese and normal-weight adolescents.