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Background and Purpose: In recent decades, elevated levels of homocysteine (Hcy) have been found to be associated with an increased risk of vascular events. Additionally, in some case-control studies, hyperhomocysteinaemia has been found to be related to higher intima-media thickness (IMT), but the results are inconclusive. Therefore, in the present study we intended to assess the relationship between serum levels of Hcy and IMT in normotensive and hypertensive adolescents., Patients and Methods: 59 normotensive 47 white coat hypertensive and 73 sustained hypertensive adolescents were included in our study. IMT of the common carotid arteries was measured by B-mode ultrasonography. Plasma NOx as well as homocysteine levels were measured in all cases. The relationship between IMT and Hcy and NOx were assessed by a pooled analysis. Additionally, serum levels of Hcy and NOx were compared between normotensives and hypertensive subgroups., Results: IMT was elevated in hypertensive adolescents (means ± SD: 0.055 ± 0.01 cm) compared with normotensives (0.048 ± 0.008 cm, p < 0.01). Higher serum concentrations of homocysteine were measured in hypertensive teenagers (11.9 ± 7.25 µmol/l for hypertensive and 9.85 ± 3.12 µmol/l for normotensives respectively, p < 0.01). In contrast to this, serum NOx was lower in patients (28.8 ± 14.9 µmol/l) compared with controls (38.8 ± 7.6 µmol/l, p < 0.01). The pooling of homocysteine and IMT data of hypertensive and normotensive adolescents revealed a significant positive relationship between the two parameters (r = 0.43, p < 0.001)., Conclusions: We conclude that elevated serum levels of homocysteine may play a role in increased IMT in adolescent hypertension.

Background and Purpose: Although its incidence is not high, adolescent hypertension may predict hypertension and increased cardiovascular risk in adulthood. Therefore, the aim of the present study was to assess whether cerebrovascular reactivity is altered in adolescent white coat and sustained hypertensive patients compared to healthy teenagers., Methods: Fifty-nine normotensive, 47 white coat hypertensive (WCH), and 73 sustained hypertensive (SH) adolescents were studied. WCH and SH were differentiated by ambulatory blood pressure monitoring. Cerebrovascular reactivity was assessed by transcranial Doppler breath-holding test and was expressed in percent (%) change to the resting cerebral blood flow velocity value., Results: The percent increase in middle cerebral artery mean blood flow velocity after 30 s of breath holding was lower in both WCH (5.3 ± 3.1%) and SH (9.5 ± 2.6%) groups indicating lower vasodilatory reactivity compared to healthy adolescents (12.1 ± 2.2%). Additionally, serum nitric oxide (NOx) concentrations were lower in both WCH (30.6 ± 11 μM) and SH (30.7 ± 22.4 μM) groups compared to controls (38.8 ± 7.6 μM)., Conclusions:   Both white coat and sustained hypertension result in decreased vasodilatory reaction to CO(2) in adolescents, suggesting involvement of the cerebral arterioles. The present study underlines the importance of early recognition and proper treatment of adolescent hypertension in order to prevent long-term cardiovascular complications., (© 2010 The Author(s). European Journal of Neurology © 2010 EFNS.)

Aim: To obtain epidemiological data on the blood pressure (BP) status of high school students and factors influencing BP., Methods: Subjects filled out a questionnaire and three repeated BP measurements were taken. All high school attending students in Debrecen (final sample n = 10,194, mean age 16.6 ± 1.0 years) participated in the study., Results: Boys had significantly higher systolic BP (+11.3 mm Hg) and diastolic BP (+2.2 mm Hg) than girls (p < 0.001). There was a positive correlation between weight and BP (r(syst) = 0.42, r(diast) = 0.29), height and BP (r(syst) = 0.33, r(diast) = 0.15), body mass index (BMI) and BP (r(syst) = 0.31, r(diast) = 0.27). Multiple regression was used for statistical analysis. Gender (β = 0.36), BMI (β = 0.25), hypertension of parents (father β = 0.04 and mother β = 0.02), smoking, alcohol consumption and age determined systolic outcomes in descending order. For the diastolic model, BMI remained a strong determining factor (β = 0.25) and gender was also significant (β = -0.09). Entering independents together accounted for 28.2% of the total variance in systolic and for 18.1% in diastolic BP., Conclusion: Body weight is central to determining BP. Because that is an alterable cardiovascular risk factor, we presume that lifestyle modification will not only result in reduced weight, but also in decreased BP., (Copyright © 2011 S. Karger AG, Basel.)

Aims and Scope: The aim of the present study was to assess whether a difference exists between intima-media thickness and the left ventricular mass index in healthy nonhypertensive, white-coat hypertensive and sustained hypertensive adolescents., Patients and Methods: Fifty-nine normotensive and 120 hypertensive adolescents were enrolled in our study. Hypertensive patients were classified into white-coat hypertension (WCH) and sustained hypertension groups based on 24-h ambulatory blood pressure measurements. Both normotensive and hypertensive individuals underwent routine laboratory tests, intima-media thickness measurements on the common carotid arteries and transthoracic echocardiography to measure the left ventricular mass index (LVMI)., Results: Intima-media thickness was higher both in WCH and sustained hypertension compared with healthy normotensive individuals (controls: 0.048 ± 0.01 cm, WCH: 0.056 ± 0.01 cm, sustained hypertension: 0.054 ± 0.012 cm, both P < 0.001 compared with controls, nonsignificant difference between the two hypertensive groups). There was no difference between the LVMI of control individuals and WCH (LVMI: 35.5 ± 10.3 g/m and 37.7 ± 11.2 g/m respectively, P = 0.87). LVMI in sustained hypertension group (LVMI: 44.1 ± 14.1 g/m) was significantly higher both compared with WCH (P < 0.05), and healthy adolescents (P < 0.001)., Conclusion: Target-organ damage develops in a stepwise fashion in adolescent hypertension. An increased intima-media thickness can be demonstrated not only in the sustained but also in the white-coat form of adolescent hypertension.

Aims: To assess whether a gender difference exists in adolescent hypertension and its target organ damage and to compare potential confounding factors and target organ damage in hypertensive and normotensive adolescent girls., Methods: From the Debrecen Hypertension Study, the anthropometric, blood pressure, and laboratory data as well as intima-media thickness (IMT) and left ventricular mass index (LVMI) of 58 hypertensive boys, 56 hypertensive girls, and 30 normotensive girls were analyzed., Results: Both systolic and mean blood pressure values were higher in adolescent hypertensive boys than in girls. This difference was also present when comparing 24-hour average blood pressure values. Plasma concentrations of nitric oxide (NO) and endothelin-1 were not different in the two gender groups. IMT of the carotid arteries were similar in hypertensive boys and girls, but a significantly higher LVMI was detected in boys. A significant difference was detected in anthropometric data (height, weight, and body mass index [BMI]), plasma concentration of NO (lower levels in hypertensives), and IMT in hypertensive and normotensive girls (higher IMT in hypertensive girls)., Conclusions: There is a difference between the severity of hypertension between hypertensive adolescent girls and boys. Hypertensive girls differ from normotensive girls not only in blood pressure values but also in risk factors and subclinical target organ effects. Further studies are needed to explain the gender differences in adolescent hypertension. The potential role of sex hormones in hypertensive teenagers also needs to be clarified in future works.

The prevalence of adolescent hypertension is increasing. The national epidemiological study found 2.5% prevalence, while it is 4.5% according to the newest international survey. Repeated casual blood pressure measurements, but not ambulatory blood pressure monitoring is needed for the diagnosis of adolescent hypertension on the basis of the presently available European guideline. At the last decade growing evidence came into light for ambulatory blood pressure monitoring in adolescence. These data show better correlation with end-organ damages than casual measurements. In patients with hypertension diagnosed based on repeated casual blood pressure measurements, 24-hour monitoring showed normal blood pressure in 21-47%, so this is the rate of white coat hypertension. Masked hypertension can also be diagnosed with the help of this method, which has a prevalence of 7-11%. We can also get useful data for secondary forms of hypertension. Until the appearance of the new European guidelines, more frequent use of ambulatory blood pressure monitoring is affordable. The confirmation of the diagnosis based on elevated casual blood pressure data is important. Ambulatory blood pressure monitoring is suggested in cases suspicious for white coat or masked hypertension, in cases of target organ damages or therapy resistant hypertension. Before administration of pharmaceutical therapy in adolescence hypertension - according to author's opinion - ambulatory blood pressure monitoring is absolutely necessary.

Background and Purpose: To assess the role of the nitric oxide-endothelin imbalance in the development of target-organ damages (carotid intima-media thickness and left ventricular mass index) in adolescent hypertension., Methods: 125 adolescents--67 hypertensive and 58 normotensive--underwent routine anthropology (height, weight) and blood pressure measurements, and laboratory (glucose, cholesterol and triglyceride levels) testing as well as sampling blood for determination of the plasma concentrations of nitric oxide (NOx) and endothelin-1 (ET-1), followed by measurement of the carotid intima-media thickness (IMT) and left ventricular mass index (LVMI)., Results: Plasma concentration of NOx was significantly lower (27.7+/-13.7 vs. 35.8+/-7.0 micromol/l, respectively, p<0.001) and ET-1 was higher (3.11+/-3.9 vs. 1.09+/-1.07 fmol/ml, respectively, p<0.001) in hypertensive adolescents than that of controls. NOx negatively, endothelin positively correlated with blood pressure values, especially with systolic BP. An inverse relationship has been found between NOx and ET-1 concentrations (r=-0.29, p<0.003). In this adolescent population body weight, systolic blood pressure and plasma ET-1 were the most important factors influencing IMT, whereas LVMI correlated with height and weight and systolic BP of the teenagers., Conclusions: NO/endothelin imbalance seems to play a role in the development of hypertension and target-organ damages in adolescence. Further studies are encouraged in order to clarify the pathophysiological role of NO/endothelin imbalance in adolescent hypertension.

This review summarises the role of the endothelium in the regulation of the vascular tone, emphasizes the importance of nitric oxide and endothelin at the vasodilator and vasoconstrictor physiological processes. Mainly, the nitric oxide is responsible for the basal tone of the vasculature, but plenty of modifying factors (endothelin, angiotensin-II, prostacyclin) have also important effects. Endothelial dysfunction observable in hypertension, which characterised by disorder of the endothelium-dependent relaxation, and predominance of the vasoconstrictor processes. Disorder of synthesis, decreased biological activity and increased degradation of the nitric oxide could play a role in the fall of the basal vasodilator tone, as well as other factors influencing the production of nitric oxide. Due to a relaxation disorder, the vasoconstrictor endothelin come to the front, following morphological changes of the vessels, afterwards. Endothelial dysfunction of the medium size arteries lead to thickening of the intima, what can follow by non-invasive measurements at the common carotid arteries. It is unambiguous in hypertensive patients that augmenting the tone of the resistance vessels, the peripheral vascular tone increases. It is proved in hypertensive adults that damaged function of the cerebral arterioles results in decrease of the vasoreactivity following a hypo- or hypercapnic stimuli. The imbalance of the nitric oxide-endothelin system is not only a process what helps to partly explain the pathophysiology of hypertension, but also a therapeutic aim preventing the process of atherosclerosis.

This review summarises the recent epidemiological data on hypertension, the aims of the treatment of hypertension, and emphasizes the importance of the modification of target organ damages and accelerated clinical conditions. Because the pathogenesis of hypertension is extremely complex, the therapy most likely requires a combined drug administration. The modern third generation dihydropyridine calcium channel blocker, amlodipine, not only has a favourable antihypertensive and anti-ischemic effect, but anti-atherosclerosis properties as well. There are plenty of evidence which demonstrate that lisinopril, a first line antihypertensive agent, has a positive effect in the treatment of left ventricular hypertrophy, retinopathy and nephropathy, and also has a favourable outcome after myocardial infarction and in heart failure. The combined administration of the two drugs leads to a favourable additive effect, with a decrease in the number and severity of side effects. The results of the ASCOT study proved a favourable effect with amlodipine based, combination therapy with an ACE-inhibitor, compared with the traditional beta-blockers and diuretics. The data of the CAFE sub-study showed, that in spite of the similar peripheral antihypertensive effect, the amlodipine based therapy decreased the central aortic pulse pressure to a greater extent. The central aortic pressure showed a good correlation with the end-points of the study, respectively. The results of the Hungarian multicenter study (HAMLET) proved the effective and safe administration of the two drugs in combination. Based on the above evidence, the fixed-dose combination of the CCB-ACE inhibitor (amlodipine-lisinopril) has not only effective blood pressure reducing properties, but also results in cardiovascular risk reduction, good tolerability and favourable compliance.

Background: It is known that cerebral vasoreactivity is altered in adult arterial hypertension but no information is available about cerebral arteriolar function in hypertensive adolescents. Therefore, the aim of the present work was to assess cerebral vasoreactivity responses in adolescent hypertension., Methods: 113 hypertensive and 58 normotensive adolescents were assessed with transcranial Doppler sonography by using voluntary hyperventilation (HV) as vasoconstrictory stimulus. Absolute blood flow velocities (systolic, mean and diastolic) and pulsatility indices (PIs) at rest and after HV, as well as percentage change of the blood flow velocities after HV were compared among the groups., Results: Blood flow velocities at rest were significantly higher in hypertensive individuals, while PIs were similar in the two groups. After HV, all blood flow velocity parameters were higher among hypertensive teenagers than in healthy controls, while PIs did not differ between the two groups. Taking the relative changes after HV into account, it was found that HV induced a more pronounced change of the systolic and mean blood flow velocities of the control subjects than in hypertensive adolescents., Conclusions: Cerebrovascular reactivity to hypocapnia is decreased in hypertensive adolescents as compared to healthy teenagers. Further studies are needed to clarify the clinical significance of altered cerebral microvascular function in adolescent hypertension.

Background and Purpose: Nitric oxide (NO)/endothelin imbalance may play a role in the regulation of cerebral blood flow. The aim of the present study was to assess whether these endothelial factors influence middle cerebral artery blood flow velocities (MCAV) and cerebrovascular reactivity (CVR) in healthy and hypertensive adolescents., Subjects and Methods: 106 adolescents (61 hypertensive and 45 normotensive) underwent transcranial Doppler measurements of the middle cerebral artery at rest and after 30 s of breath-holding (BH) and 60 s of hyperventilation (HV). Additionally, NO and endothelin-1 (ET-1) concentrations of the serum were assessed. The correlation between NO and ET-1 levels as well as MCAV and CVR values was analyzed., Results: Resting MCAVs were higher among hypertensive teenagers (76.5 +/- 24 vs. 62.8 +/- 15.6 cm/s, respectively, p < 0.001). CVR values did not differ between hypertensive and healthy adolescents after the BH and HV procedure. A significant negative correlation was found between absolute MCAV values and NO concentrations. ET-1 was positively related to MCAV., Conclusions: Cerebral blood flow velocities, but not CVR values, are associated with serum NO and ET-1 concentrations in adolescents., (Copyright 2006 S. Karger AG, Basel.)

Aim: To perform a blood pressure screening program in Debrecen secondary school students according to international guidelines. To obtain epidemiological data about factors influencing adolescent blood pressure using a questionnaire. To repeat the blood pressure measurements in case of elevated systolic and/or diastolic readings, and to determinate the prevalence of adolescent hypertension in Debrecen., Patients and Methods: All high school attending students in Debrecen (n = 10359) participated in the study. Measurements were obtained by a validated, automated, digital OMRON M4 device., Results: Gender distribution was nearly equal in our sample: 50.64% male, 49.36% female. The mean age was 16.55 +/- 0.99 years. Boys were 10 cm taller and 10 kg heavier on average than girls. Hypertension in family history was prevalent in 10.8% of mothers and in 11.7% of fathers. Every fifth adolescent (19.7%) was a regularly smoker, while 12.2% of the studied population drank alcohol in a weekly basis. Leisure time sporting activity was characteristic only for 31.9%, while 11.2% of the young people usually felt stress and 15.1% regularly salted their food. Low birth weight (< 2500 gram) was recorded in 6.7% of the adolescents. Systolic and/or diastolic blood pressure exceeded the 90th percentile for the age, gender and height specific subgroups in 1614 cases. Repeated measurements were performed in 1461 cases on two different occasions. Averaging the 3 x 3 measurements, hypertension was confirmed in 216 cases. The prevalence of the disease in this population was 2.53%., Conclusion: The recognition, treatment and follow-up of hypertension among adolescent population, is of immense importance.

Purpose: The aim of this study was to determine whether a positive correlation exists between the DD genotype of angiotensin-converting enzyme (ACE) and the carotid intima-media thickness (IMT) or left ventricular mass index (LVMI) in adolescents with hypertension., Methods: We studied 120 hypertensive and 58 normotensive (control) adolescents. ACE gene polymorphism was determined by a standardized method. The IMT was measured in the common carotid arteries, and the LVMI was calculated on transthoracic echocardiography. The severity of hypertension was graded according to the results of ambulatory blood pressure monitoring as white coat, borderline, or proven hypertension. The association between ACE gene polymorphism and the obtained parameters was analyzed using analysis of variance and chi-square testing., Results: Both the IMT and LVMI were higher in hypertensive than in control adolescents. In hypertensive subjects, no relationship was found between the different ACE genotypes and the IMT: the mean (+/- standard deviation) IMT in patients with the DD genotype was 0.57 +/- 0.11 mm; in those with the DI genotype, 0.53 +/- 0.01 mm; and in those with the II genotype, 0.55 +/- 0.01 mm. The LVMI was also similar in all 3 ACE genotypes: DD, 106.7 +/- 32.3 g/m(2); DI, 102.2 +/- 38.1 g/m(2); and II, 103.2 +/- 26.3 g/m(2). The severity of hypertension as assessed by ambulatory blood pressure monitoring was independent of the ACE genotype., Conclusions: Target-organ damage (left ventricular hypertrophy and carotid atherosclerosis) is detectable in adolescents with hypertension and, in those subjects, ACE genotype polymorphism is not correlated with the severity of target-organ damage as measured by IMT and LVMI., (Copyright 2004 Wiley Periodicals, Inc.)

Aim: Authors report on preliminary results of cerebral vasoreactivity-tests performed in frame of the Debrecen Hypertension Study among hypertensive and healthy adolescents., Methods: Investigators measured blood flow velocities before and after 30 seconds of breath holding using transcranial Doppler sonography., Results: Blood flow velocities at rest were significantly higher in the hypertensive that in the healthy adolescent group. Breath holding induced less intensive cerebral vasoreactivity response in the hypertensive than in the normotensive group., Conclusion: It is concluded that altered arteriolar function of the cerebral arterioles can be detected already in this early stage of hypertension.

Background: The aim of the present work was to investigate intima media thickness (IMT) in healthy and in hypertensive adolescents and its influencing factors., Methods: 103 hypertensive and 58 healthy adolescents were studied. IMT was measured in the common carotid artery using B-mode ultrasonography. Additionally, laboratory parameters (blood glucose, cholesterol, triglycerides, HDL- and LDL-cholesterols) and left ventricular mass indices were obtained., Results: IMT in the common carotid artery was higher in hypertensive adolescents (means +/- SD: 0.55 +/- 0.11 mm) than in healthy control subjects (0.48 +/- 0.08 mm, p < 0.001). Similarly, a higher left ventricular mass index was measured in hypertensive (103.2 +/- 30.6 g/m(2)) than in healthy teenagers (91.1 +/- 25.2 g/m(2), p < 0.001). In general, IMT in adolescents was associated with age, weight, body mass index, left ventricular mass index and average systolic and diastolic blood pressure values of the subjects. By assessing the multivariate association between IMT and other factors, intima-media thickness was only associated with age and left ventricular mass index of the hypertensive subjects and was independent from all the investigated factors in normotensive controls., Conclusions: Our data suggest an ongoing target-organ damage in adolescent hypertension. These patients need to be subjected to early diagnostic methods, treatment and a regular follow-up, in order to avoid severe clinical manifestations of secondary target-organ damage due to hypertension., (Copyright 2003 S. Karger AG, Basel)

The purpose of this work was to estimate the prevalence of hypertension and cardiovascular risk factors and its association with sociodemographic, behavioural and lifestyle characteristics among the adult population of the city of Debrecen, Hungary.A cross-sectional study was conducted in 1996. Amongst 21 800 inhabitants aged 30-65 y risk screening for cardiovascular disease (CVD) was estimated by a questionnaire that included sociodemographic, lifestyle characteristics, family history of CVD and results of self-reported data of body weight, height and blood pressure. Of the total of 19 961 surveyed sample, 37.02% were considered to be hypertensive, 53.73% were overweight, 32.18% were current smokers and 58.85% were physically inactive. Hypertensives were older than normotensives (50.81+/-9.01 vs 44.78+/-8.97 y, P<0.001). The prevalence of various risk factors amongst hypertensives as compared to normotensives were overweight (68.49 vs 45.06%, P<0.0001), current smoking (28.38 vs 34.41%, P<0.0001), physical inactivity (64.78 vs 55.36%, P<0.001), and high alcohol consumption (1.91 vs 1.06%, P<0.01). Of the hypertensives 37.11% were on drug therapy. Of those on therapy, only 17.03% had normal blood pressure. Being overweight and having low physical activity was positively associated with hypertension (OR=2.25, CI=2.11-2.40) and (OR=1.26, CI=1.15-1.38). Manual work, a family history of CVD, low education, and the male gender were also associated with hypertension and more CVD risk factors. These findings illustrate a very high prevalence of hypertension and CVD risk factors in Debrecen, indicating the importance of the need for more effective prevention programmes and control of hypertension in Hungary.

The authors summarize the determining and influencing factors of adolescent hypertension. An overview of the definition and prevalence of hypertension in adolescence is given and the predictive role of the adolescent hypertension on the incidence of adult cardiovascular diseases is pointed out. According to the previous literature data, adult hypertension is more frequent in those people who have had hypertension in their adolescence. There are no widely used, population-based nomograms of adolescent hypertensives available. According to the opinion of the authors, a population-based hypertension screening program would help in delineating the factors influencing adolescent blood pressure, and the most frequent risk factors for hypertension in Hungary. With the follow-up and appropriate treatment of the hypertensives the reduction of target-organ damages may be possible.