1. Obesity Hypertension and Endothelial Dysfunction in Pediatric Patients
Jen-Jar Lin, M.D.,Ph.D.
Division of Nephrology
Department of Pediatrics

2. Hypopnea in Pediatric Patients with Obesity Hypertension
Question:
Why some obese pediatric patients are hypertensive and some are not?
Is sleep apnea one of the contributing factors for obesity hypertension in pediatric patients?

3. Hypothesis
Obesity
Hypertension
OSAS

6. Table 4 Correlation coefficients in obese patients

7. Forward Stepwise multiple regression analysis obese patients (n = 56); PSG variables log transformed
Dependent variable: SBPscore or DBPscore
Independent variables: BMIscore, Arousal Index, HI, AHI
SBPscore(R2 = 23%): BMIscore (R2 = 14%, p = 0.004)
HI (R2 = 7%, p = 0.04)
DBPscore (R2 = 28%): HI (R2 = 18%, p = 0.01)
BMIscore (R2 = 10%, p = 0.001)

8. Obese patients

9. Identification of early surrogate markers for end-organ damage and CVD in pediatric patients with hypertension or obesity

10. Both obesity and hypertension are independent risk factors of CVD and mortality in adults
Childhood obesity and hypertension are associated with the future development of obesity and systolic hypertension in adulthood
However, since CVD is usually not manifested until later in adulthood, data regarding the effect of pediatric antihypertensive therapy on the future CVD risk is not known.
End-organ damage from hypertension or obesity, such as LVH or microalbuminuria, may take years to develop.

11. Identification of early surrogate markers for future CVD or end-organ damage in pediatric hypertensive patients will allow timely interventions and determination of treatment efficacy
Endothelial dysfunction and an increased intima-media thickness (IMT) has been shown in adults with hypertension, DM, or obesity.
Carotid IMT is an early CVD risk marker in adults.
An increased aortic IMT has been demonstrated in children with familial hypercholesterolemia or IDDM, which is associated with their diastolic BP.

12. Goal of the study To examine if endothelial dysfunction and
intima-media thickness can be early surrogate
markers for CVD or end-organ damage markers
in pediatric patients with hypertension

13. Endothelial dysfunction assessed by the hyperemic response to ischemia in brachial artery

14. Right brachial artery, before 4-min occlusion of the forearm
Mean diameter = 4.23 mm

15. Right brachial artery, at 1.5 min after forearm occlusion
Mean diameter = 4.6 mm ,  10% increase in diameter

16. Right brachial artery, at 5 min after forearm occlusion
Mean diameter = 4.47 mm

17. Intima-Media Thickness (IMT) of abdominal aorta, right brachial artery, and common carotid artery

18. Right brachial artery, mean IMT = 0.4 mm

19. Significance If an increased IMT and/or endothelial dysfunction
Is demonstrated to be an early surrogate marker for
end-organ damage in pediatric patients with
hypertension, it can be used as the endpoint and
the guide for antihypertensive therapy in these
patients.