abc Arquivos Brasileiros de Cardiologia Arq. Bras. Cardiol. 0066-782X 1678-4170 Sociedade Brasileira de Cardiologia - SBC São Paulo, SP, Brazil TDLWhCRjMmxtqVRYxhGTWqn 00005 S0066-782X2004000200005 S0066-782X(04)08200205 10.1590/S0066-782X2004000200005 Artigos Originais Comparação do perfil lipídico, pressão arterial e aspectos nutricionais em adolescentes, filhos de hipertensos e de normotensos Elias Maria Cristina Bolívar Max Samuel Mattos Fonseca Francisco Antonio Helfenstein Martinez Tania Leme da Rocha Angelini Japy Ferreira Celso Kasinski Nelson de Paola Angelo Amato Vincenzo Carvalho Antonio Carlos Camargo São Paulo Universidade Federal de São Paulo Escola Paulista de Medicina Brazil 02 2004 82 2 139 142 19 11 2002 31 03 2003 This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

OBJETIVO: Comparar a pressão arterial, o perfil lipídico, o consumo alimentar e dados antropométricos em adolescentes com ou sem antecedente familiar de hipertensão arterial. MÉTODOS: Foram avaliados 43 adolescentes de ambos os sexos, na faixa etária entre 11 a 18 anos, sendo 20 filhos de hipertensos e 23 de normotensos e examinados: a pressão arterial, o consumo alimentar, dados antropométricos, o perfil lipídico e o resultado da orientação dietética (American Heart Association). RESULTADOS: Os filhos dos hipertensos mostraram maiores valores basais de pressão arterial sistólica (109 ± 3 vs. 99 ± 2 mm Hg, p=0,01) e diastólica (68 ± 2 vs. 62 ± 2 mm Hg, p=0,04), da relação CT/HDL-c (4,1 ± 0,3 vs. 3,2 ± 0,2, p<0.01) e de LDL-c/HDL-c (2,7 ± 0,2 vs. 1,9 ± 0,1, p<0,01) e menores valores de HDL-c (43 ± 2 vs. 53 ± 2 mg/dL, p<0,005). O consumo alimentar e medidas antropométricas analisadas não diferiram entre os grupos. A intervenção dietética, embora tenha resultado em reduções no índice de massa corpórea (21,0± 1,2 vs. 20,1 ± 1,1 kg/m², p<0,01), não modificou a dislipidemia presente nos filhos de hipertensos. CONCLUSÃO: Encontraram-se maiores níveis de pressão arterial e perfil lipídico mais desfavorável entre filhos de hipertensos, onde os níveis baixos de HDL-c foram o achado mais relevante e independente de variáveis antropométricas ou nutricionais.

 adolescência pressão arterial hábitos alimentares lipídios 16 03 2004

ARTIGO ORIGINAL

Comparação do perfil lipídico, pressão arterial e aspectos nutricionais em adolescentes, filhos de hipertensos e de normotensos

Maria Cristina Elias; Max Samuel Mattos Bolívar; Francisco Antonio Helfenstein Fonseca; Tania Leme da Rocha Martinez; Japy Angelini; Celso Ferreira; Nelson Kasinski; Angelo Amato Vincenzo de Paola; Antonio Carlos Camargo Carvalho

Escola Paulista de Medicina - UNIFESP - São Paulo, SP

Endereço para correspondência

RESUMO

OBJETIVO: Comparar a pressão arterial, o perfil lipídico, o consumo alimentar e dados antropométricos em adolescentes com ou sem antecedente familiar de hipertensão arterial.

MÉTODOS: Foram avaliados 43 adolescentes de ambos os sexos, na faixa etária entre 11 a 18 anos, sendo 20 filhos de hipertensos e 23 de normotensos e examinados: a pressão arterial, o consumo alimentar, dados antropométricos, o perfil lipídico e o resultado da orientação dietética (American Heart Association).

RESULTADOS: Os filhos dos hipertensos mostraram maiores valores basais de pressão arterial sistólica (109 ± 3 vs. 99 ± 2 mm Hg, p=0,01) e diastólica (68 ± 2 vs. 62 ± 2 mm Hg, p=0,04), da relação CT/HDL-c (4,1 ± 0,3 vs. 3,2 ± 0,2, p<0.01) e de LDL-c/HDL-c (2,7 ± 0,2 vs. 1,9 ± 0,1, p<0,01) e menores valores de HDL-c (43 ± 2 vs. 53 ± 2 mg/dL, p<0,005). O consumo alimentar e medidas antropométricas analisadas não diferiram entre os grupos. A intervenção dietética, embora tenha resultado em reduções no índice de massa corpórea (21,0± 1,2 vs. 20,1 ± 1,1 kg/m², p<0,01), não modificou a dislipidemia presente nos filhos de hipertensos.

CONCLUSÃO: Encontraram-se maiores níveis de pressão arterial e perfil lipídico mais desfavorável entre filhos de hipertensos, onde os níveis baixos de HDL-c foram o achado mais relevante e independente de variáveis antropométricas ou nutricionais.

Palavras-chave: adolescência, pressão arterial, hábitos alimentares, lipídios

Apesar da maior ênfase na população adulta ao elo de ligação existente entre pressão arterial com doença arterial coronariana, acidentes vasculares cerebrais e doenças renais, os valores de pressão arterial na infância parecem associados à hipertensão em idade mais avançada1.

A prevalência de hipertensão arterial sistêmica em crianças e adolescentes é estimada em 6 e 8%, respectivamente2. Considerando esses aspectos, torna-se importante que os adolescentes sejam orientados para a prevenção dos fatores de risco, como a obesidade, excessiva ingestão de sal e sedentarismo, que parecem associados à elevação dos valores da pressão arterial com a idade3.

Além disso, perfil lipídico desfavorável e elevação da pressão arterial, particularmente em conjunto a outros fatores de risco, representam pela Organização Mundial de Saúde (OMS)4, uma condição associada ao maior desenvolvimento da aterosclerose, desde a infância.

Estudos epidemiológicos têm mostrado que os hipertensos apresentam, com maior freqüência, perfil lipídico desfavorável que a população em geral5-7. No estudo Tromso6 uma interrelação biológica entre a pressão arterial e os lipídios pareceu associar-se à doença arterial coronariana.

A nutrição pode ter um papel fundamental na prevenção da hipertensão arterial sistêmica8. Práticas nutricionais inadequadas, como consumo elevado de alimentos ricos em gordura saturada, colesterol e sódio, em conjunto com o sedentarismo, têm sido relacionadas a uma variedade de doenças crônicas, particularmente hipertensão, hiperlipidemia e diabetes mellitus, condições freqüentemente associadas na vida adulta9-11.

Com base no início precoce da aterosclerose, em crianças e adolescentes, e ainda, pela crescente importância da hipertensão arterial e sua interrelação com dislipidemias na gênese da doença coronariana em adultos, o propósito deste estudo foi verificar a pressão arterial e analisar o padrão da dislipidemia nesta população. O estudo ainda examinou possíveis modificações no perfil lipídico, por uma intervenção nutricional controlada.

Métodos

A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Universidade Federal de São Paulo/Escola Paulista de Medicina e iniciada após a obtenção do consentimento informado por um dos pais.

Foram avaliados 20 adolescentes de ambos os sexos, de 11 a 18 anos, filhos de pais hipertensos2, acompanhados nos ambulatórios da Disciplina de Cardiologia. Os controles consistiram de 23 jovens voluntários, filhos de pais normotensos. Considerados como filhos de hipertensos os que possuíam pelo menos um dos pais hipertenso, sendo que todos foram controlados de acordo com a idade, sexo e grau de maturação sexual, segundo os critérios de Tanner 12 (tab. I). Para a classificação dos filhos de hipertensos ou normotensos todos os pais dos adolescentes tiveram a pressão arterial mensurada (dados não apresentados).

Os adolescentes tiveram seu perfil lipídico determinado após jejum alimentar de 12 a 14h por método enzimático colorimétrico, sendo o LDL-c estimado pela fórmula de Friedwald 13. Todas as análises foram realizadas em aparelho Ópera (Bayer, Alemanha).

O exame da pressão arterial foi realizado de maneira cega, utilizando-se o esfigmomanômetro de coluna de mercúrio, na posição sentada, realizando-se duas medidas após 5min, com intervalo de 1 a 2min entre elas 2.

Para a análise dos resultados, utilizamos como referência as tabelas de percentis para meninos e meninas na faixa etária de 10 a 17 anos do Second Task Force on Blood Pressure Control in Children, 198714.

Foram avaliados os hábitos alimentares por meio da freqüência dos alimentos, recordatório alimentar de 24h e registro alimentar de três dias, com a participação dos pais. Com base nesses dados, medidas antropométricas e exames laboratoriais, foram elaboradas as orientações nutricionais individualizadas para os adolescentes, monitoradas mensalmente durante um período de 16 semanas.

Para os cálculos e elaborações das orientações nutricionais, foram utilizados os programas de apoio à nutrição - CIS-EPM/ UNIFESP e o virtual nutri–USP15,16.

As orientações nutricionais foram elaboradas com base nas recomendações dietéticas (RDAs), para os macro e micronutrientes, de acordo com a faixa etária estudada, acrescidas das recomendações da American Heart Association (AHA, fase I) quando detectada a presença de dislipidemias3.

Foram obtidos o peso, estatura, índice de massa corporal, pregas cutâneas do tríceps e subescapular, além da circunferência abdominal (tab. I).

Os valores obtidos do índice de massa corpórea foram avaliados em percentis, de acordo com os critérios estabelecidos por Sichieri e Allam17, para a faixa etária de 10 a 17 anos e 11 meses, e para os adolescentes acima desta idade, de acordo com o inquérito americano National Health and Nutrition Examination Survey (NHANES I)18.

Os percentis relacionados às medidas das pregas cutâneas foram avaliados de acordo com o inquérito americano NHANES I e os da circuferência da cintura segundo os critérios de Freedman e cols.19

Os dados foram expressos em média ± erro padrão da média. Para a comparação das variáveis contínuas foi utilizado o teste t de Student não pareado, e utilizado o teste pareado para o exame da intervenção nutricional. A homogeneidade dos grupos foi examinada pelo teste do qui-quadrado. Fixou-se em 5% o nível de rejeição da hipótese de nulidade.

Resultados

Os valores de pressão arterial sistólica (PAS) e diastólica (PAD) obtidos foram maiores para os filhos de hipertensos do que para os filhos de normotensos, embora dentro dos percentis da normalidade para a idade (tab. I), não tendo sido constatadas diferenças entre os grupos em relação às dobras cutâneas (tríceps e subescapular), circunferência abdominal, bem como para o índice de massa corpórea obtido, mas houve redução deste parâmetro após a intervenção nutricional (tab. II).

Embora não tenham sido verificadas diferenças entre as dietas consumidas pelos adolescentes no período basal (tab. III), menor valor calórico total e tendência para aumento do consumo de gordura monoinsaturada e redução da gordura saturada foram obtidos após a orientação nutricional (tab. II).

A figura 1 mostra que os descendentes dos hipertensos apresentaram menores valores basais de HDL-c (43 ± 2 vs. 53 ± 2 mg/dL, p<0,005), e maiores índices de CT/HDL-c (4,1 ± 0,2 vs. 3,2 ± 0,2, p<0,001) e LDL-c/HDL-c (2,7 ± 0,2 vs. 1,9 ± 0,1, p<0,001) em comparação aos filhos de normotensos. Estas populações não se diferenciaram em relação ao colesterol total (168 ± 8 vs. 166 ± 5 mg/dL, ns) e LDL-c (108 ± 8 vs. 97 ± 5 mg/dL, ns) obtidos na condição basal. Após o aconselhamento nutricional, restrito aos filhos de hipertensos com dislipidemia, não foram observadas modificações em comparação ao novo perfil lipídico obtido (tab. II).

Discussão

Nosso estudo em adolescentes identificou, entre os filhos de hipertensos, maiores níveis de pressão arterial e perfil lipídico mais desfavorável (redução de HDL-c e das relações CT/HDL-c e LDL-c/HDL-c) quando comparados aos filhos de pais normotensos. Considerando que todos estes aspectos estiveram associados a um maior desenvolvimento de aterosclerose nas crianças e adolescentes nos estudos anatomopatológicos de Bogalusa20 e PDAY21, é sugerida uma maior atenção à prevenção primária de doença cardiovascular.

Embora dentro de valores de distribuição de pressão arterial considerados normais para a faixa etária estudada, a observação de que os filhos de hipertensos apresentaram maiores valores de pressão sistólica e diastólica, em relação ao grupo de adolescentes controles, também sugere, que valores hoje considerados normais para esses jovens, talvez possam ser revistos no futuro, permitindo ao menos a identificação de uma população com maior probabilidade de desenvolvimento de hipertensão e aterosclerose na vida adulta. Todavia, estudos prospectivos amplos, na visão moderna da hipertensão e aterosclerose, serão necessários para a elaboração de novos critérios diagnósticos. De fato, os mais jovens deveriam ser precocemente identificados, quanto ao seu risco cardiovascular, de forma a implementar uma prevenção mais efetiva.

Em concordância com os nossos achados, uma fraca correlação para a pressão arterial entre cônjuges e entre pais e filhos adotivos, tem sido observada, mas o índice de correlação eleva-se entre os pais e filhos consangüíneos, apesar de compartilharem dos mesmos hábitos, sugerindo uma forte influência genética no comportamento da pressão arterial22-25.

De forma interessante, em nosso estudo, valores mais baixos do HDL-c foram observados entre os filhos de hipertensos, a despeito de similar índice de massa corpórea e hábito alimentar para o consumo de gorduras saturadas, poli e monoinsaturadas, além de carboidratos e proteínas.

Giannini e cols.7, em nosso meio, observaram uma maior freqüência de dislipidemia entre familiares de hipertensos, também identificando, entre outras anormalidades, valores mais baixos para o HDL-c. Além disso, resultados semelhantes foram relatados no estudo Tromso6, em que os hipertensos apresentaram valores elevados de colesterol e triglicerídeos, além de valores menores de HDL-c. Em outro estudo epidemiológico, os indivíduos hipertensos apresentaram dislipidemias com maior freqüência que os normotensos, existindo uma relação entre a hipertensão e a hipercolesterolemia, independentemente de outras variáveis, como por exemplo, a idade e o índice de massa corpórea26.

A importância do HDL-c como um precoce marcador de alterações metabólicas neste grupo de adolescentes filhos de pais hipertensos parece estabelecida por esses vários estudos e pode representar um dos mecanismos de aceleração da aterosclerose na hipertensão, por comprometimento do transporte reverso do colesterol.

Em relação aos hábitos alimentares, observamos que os adolescentes dos dois grupos se alimentam de maneira semelhante, com ingestão de nutrientes ricos em colesterol, gordura saturada e sódio, acima do recomendado pelo III Consenso Brasileiro de Hipertensão Arterial2, e baixo consumo de fibras, em desacordo com as recomendações da prevenção cardiovascular nesta faixa etária27-32.

Em conclusão, nosso estudo identificou um perfil de risco desfavorável entre os filhos de hipertensos. Novos critérios na estratificação do risco cardiovascular, em crianças e adolescentes, com maior sensibilidade na identificação de parâmetros pressóricos e lipídicos anormais, parecem relevantes. Neste contexto, maior ênfase ao controle de fatores de risco, incentivo à atividade física, além da correção dos hábitos alimentares desde a infância, de maneira individualizada naqueles de maior risco, poderiam reduzir ou postergar os eventos cardiovasculares na vida adulta.

ndereço para correspondência

Francisco Helfenstein Fonseca

Setor de Lípides, Aterosclerose e Biologia Vascular - UNIFESP

Rua Pedro de Toledo, 458

Cep 04039-001 - São Paulo, SP

Recebido para publicação em 19/11/02

Aceito em 31/3/03

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Dietary fat and adult diseases and the implications for chidhood nutrition: an epidemiologic approach Am J Clin Nutr 2000 1291 6 72 Law M Original Articles Comparison of the lipid profile, blood pressure, and dietary habits of adolescents and children descended from hypertensive and normotensive individuals

OBJECTIVE: To compare blood pressure, lipid profile, food intake, and anthropometric data of adolescents with or without a familial history of hypertension. METHODS: Forty-three adolescents from both sexes were assessed, with ages ranging from 11 to 18 years old. Twenty had hypertensive parents, and 23 had normotensive parents. The following variables were examined: blood pressure, food intake, anthropometric data, lipid profile, and the results of following dietary guidelines (American Heart Association). RESULTS: The offspring of hypertensive parents had greater baseline systolic blood pressure (109 ± 3 vs. 99 ± 2 mm Hg, P=0.01), diastolic blood pressure (68 ± 2 vs. 62 ± 2 mm Hg, p=0.04), greater TC/HDL-C ratio (4.1 ± 0.3 vs. 3.2 ± 0.2, P<0.01), and greater LDL/HDL-C (2.7 ± 0.2 vs. 1.9 ± 0.1, P<0.01), and smaller values of HDL-C (43 ± 2 vs.53 ± 2 mg/dL, P<0.005). Dietary intake and anthropometric measures assessed did not differ between the groups. Even though dietary intervention resulted in reductions in body mass index (21.0± 1.2 vs. 20.1 ± 1.1 kg/m², P<0.01), it did not change dyslipidemia present in the offspring of hypertensive individuals. CONCLUSION: Increased blood pressure levels and less favorable lipid profiles are found among offspring of hypertensive parents, where low levels of HDL-C were the most relevant finding regardless of anthropometric or nutritional variables.

 adolescence blood pressure dietary habits lipids

ORIGINAL ARTICLE

Comparison of the lipid profile, blood pressure, and dietary habits of adolescents and children descended from hypertensive and normotensive individuals

Maria Cristina Elias; Max Samuel Mattos Bolívar; Francisco Antonio Helfenstein Fonseca; Tania Leme da Rocha Martinez; Japy Angelini; Celso Ferreira; Nelson Kasinski; Angelo Amato Vincenzo de Paola; Antonio Carlos Camargo Carvalho

Escola Paulista de Medicina - UNIFESP - São Paulo, SP - Brazil

Correspondence

ABSTRACT

OBJECTIVE: To compare blood pressure, lipid profile, food intake, and anthropometric data of adolescents with or without a familial history of hypertension.

METHODS: Forty-three adolescents from both sexes were assessed, with ages ranging from 11 to 18 years old. Twenty had hypertensive parents, and 23 had normotensive parents. The following variables were examined: blood pressure, food intake, anthropometric data, lipid profile, and the results of following dietary guidelines (American Heart Association).

RESULTS: The offspring of hypertensive parents had greater baseline systolic blood pressure (109 ± 3 vs. 99 ± 2 mm Hg, P=0.01), diastolic blood pressure (68 ± 2 vs. 62 ± 2 mm Hg, p=0.04), greater TC/HDL-C ratio (4.1 ± 0.3 vs. 3.2 ± 0.2, P<0.01), and greater LDL/HDL-C (2.7 ± 0.2 vs. 1.9 ± 0.1, P<0.01), and smaller values of HDL-C (43 ± 2 vs.53 ± 2 mg/dL, P<0.005). Dietary intake and anthropometric measures assessed did not differ between the groups. Even though dietary intervention resulted in reductions in body mass index (21.0± 1.2 vs. 20.1 ± 1.1 kg/m2, P<0.01), it did not change dyslipidemia present in the offspring of hypertensive individuals.

CONCLUSION: Increased blood pressure levels and less favorable lipid profiles are found among offspring of hypertensive parents, where low levels of HDL-C were the most relevant finding regardless of anthropometric or nutritional variables.

Key words: adolescence, blood pressure, dietary habits, lipids

Despite greater emphasis in the adult population on the correlation between blood pressure and coronary artery disease, and strokes and renal disorders, blood pressure values during childhood seem to be associated with hypertension at a more advanced age 1.

The prevalence of systemic blood hypertension in children and adolescents is estimated at 6 to 8%, respectively 2.

Considering these facts, it is important that adolescents are guided towards the prevention of risk factors, such as obesity, excessive salt intake, and lack of exercise that seems to be associated with the increase in blood pressure values and aging 3.

Additionally, an unfavorable lipid profile and an increase in blood pressure, especially in association with other risk factors, are, according to the World Health Organization (WHO)4, conditions that favor the greater development of atherosclerosis during childhood.

Epidemiologic studies have demonstrated that hypertensive patients have unfavorable lipid profiles more frequently than does the general population 5-7. In the Tromso6 study, a biological intercorrelation between blood pressure and lipids seemed to be associated with coronary artery disease.

Diet may play an essential role in the prevention of systemic blood hypertension 8. Poor dietary habits, such as a high intake of food rich in saturated fat, cholesterol, and salt in association with the lack of exercise, have been related to several chronic diseases, especially hypertension, hyperlipidemia, and diabetes mellitus, conditions frequently associated in adult life 9-11.

Based on the early beginning of atherosclerosis in children and adolescents, and due to the increased importance of blood hypertension and its correlation with dyslipidemia in coronary disease in adults, this study aimed at verifying blood pressure and assessing lipid alterations in this population. The study also examined possible changes in lipid profile through a controlled dietary intervention.

Methods

The research was approved by the Ethics Committee for Research at the Federal University of São Paulo/Paulista School of Medicine and started after written consent was obtained from one parent.

Twenty adolescents with hypertensive parents 2 of both sexes and ages ranging from 11 to 18 years old were assessed, followed-up in the Cardiology Department wards. The control group comprised 23 volunteers with normotensive parents. Those who had at least 1 hypertensive parent were considered offspring of hypertensive parents, and all subjects were assessed according to age, sex, and level of sexual maturation according to Tanner' s criteria 12 (tab. I). Parents of adolescents had their blood pressure assessed (data not presented) to classify the 2 groups: offspring of hypertensive parents and offspring of normotensive parents.

Adolescents had their lipid profile determined after 12 to 14 hours of fasting, by using the color metric enzyme method. LDL-C was estimated using the Friedewald formula 13. All the analyses were performed with the Opera machine (Bayer, Germany).

Blind determination of blood pressure was performed, using a mercury column sphygmomanometers, in the Cardiology Department with the patient in a seated position, with 2 measures after 5 minutes, and 1- to 2-minute intervals between them 2.

The tables of percentiles for boys and girls with ages ranging from 10 to 17 years old from the Second Task Force on Blood Pressure Control in Children, 1987 14 was used as a reference for the analysis of results. Dietary habits were assessed through the frequency of food, 24-hour diet diary, and a 3-day dietary journal, with the participation of parents. Based on these data, on anthropometric measures, and on laboratory examinations, customized nutritional guidance was created for the adolescents, monitored every month for a 16-week period.

For calculation and elaboration of the nutritional guidelines, the following programs to support blood pressure were used: CIS-EPM/UNIFESP and the virtual nutri–USP 15,16.

Nutritional guidelines were elaborated based on dietary recommendations (DRs), for the macro and micro nutrients according to the age group studied, in addition to the recommendation of the American Heart Association (AHA, phase I) when the presence of dyslipidemia was detected 3.

Weight, height, body mass index, skinfold measurements (triceps, subscapular), and abdominal circumference were obtained (tab. I).

Body mass index values obtained were assessed in percentiles according to the criteria established by Sichieri and Allam 17, for the age group from 10 to 17 years and 11 months old, and for adolescents above this age, according to the American survey National Health and Nutrition Examination Survey (NHANES I) 18.

Percentiles related to the skinfold measurements were assessed according to the American survey NHANES I and the waist circumference according to Freedman et al criteria 19.

Data were expressed as mean ± SD. For the comparison of continuous variables, the nonpaired Student t test was used, and the paired test was used for the dietary intervention examination. Homogeneity of the groups was examined by the chi-square test. Level of rejection of the null hypothesis was fixed at 5%.

Results

Systolic blood pressure (SBP) and diastolic blood pressure (DBP) values obtained were greater in offspring of hypertensive parents than in those of normotensive parents, although they were within the normal percentile for the age (tab. I). Differences between the groups regarding skinfold (triceps and subscapular), abdominal circumference, as well as for body mass index obtained did not occur, but decrease in this parameter was noted after nutritional intervention (tab. II).

Although differences between the dietary intake of the adolescents in the baseline period was not observed (tab. III), lower total caloric value and a tendency to increase the consumption of monounsaturated fat and a reduction in saturated fat were obtained after dietary guidance (tab. II).

Figure 1 shows that offspring of hypertensive parents had lower baseline HDL-C values (43 ± 2 vs. 53 ± 2 mg/dL, P<0.005), and greater TC/HDL-C indexes (4.1 ± 0.2 vs. 3.2 ± 0.2, P<0.001) and LDL-C/HDL-C (2.7 ± 0.2 vs. 1.9 ± 0.1, P<0.001) in comparison to offspring of normotensive parents. These populations did not differ regarding total cholesterol (168 ± 8 vs. 166 ± 5 mg/dL, ns) and LDL-C (108 ± 8 vs. 97 ± 5 mg/dL, ns) obtained at baseline. After dietary guidance, restricted to offspring of hypertensive parents with dyslipidemia, changes were not observed in comparison to the new lipid profile obtained (tab. II).

Discussion

Our study identified, among offspring of hypertensive parents, higher blood pressure levels and a more unfavorable lipid profile (reduction in HDL-C and in the ratio TC/HDL-C and LDL-C/HDL-C) when compared with offspring of normotensive parents. Considering that all of these factors were associated with a greater development of atherosclerosis in children and adolescents in the anatomopathologic studies of Bogalusa 20 and PDAY 21, primary prevention of cardiovascular disease is suggested. Although the age group studied had normal blood pressure values, the observation that offspring of hypertensive parents had higher systolic and diastolic blood pressure values compared with those in the control group of adolescents, also suggests that values currently considered normal for these youngsters may be revised in the future, enabling, at least, the identification of a population with a greater probability of developing hypertension and atherosclerosis in adult life. However, broad prospective studies, in the modern view of hypertension and atherosclerosis, are necessary to create new diagnostic criteria. In fact, those who are younger should be identified early, regarding their cardiovascular risk, to introduce more effective prevention.

A weak correlation for blood pressure between couples and between parents and adopted children has been demonstrated, which agrees with our findings. But this correlation index is increased between parents and consanguineous children, even though they have the same habits, suggesting a strong genetic influence in the pattern of blood pressure 22-25.

In our study, lower values of HDL-C were observed between the offspring of hypertensive patients, despite the similar body mass index and dietary habits in the intake of monounsaturated, polyunsaturated, and saturated fat, as well as carbohydrates and proteins.

Giannini et al 7 observed a higher frequency of dyslipidemia among relatives of hypertensive individuals, with lower HDL-C values among other abnormalities. Additionally, similar results were reported in the Tronso study 6 where hypertensive individuals had increased values of cholesterol and triglycerides, as well as lower HDL-C values. In another epidemiologic study 26, hypertensive individuals had dyslipidemia more frequently than did normotensive individuals, with a correlation between hypertension and hypercholesterolemia, regardless of other variables, such as age and body mass index.

The importance of HDL-C as an early marker of metabolic alterations in this group of adolescents of hypertensive parents seems to be established by these several studies and may represent one of the mechanisms to accelerate atherosclerosis in hypertension, by impairment in cholesterol transport.

Regarding dietary habits, we have observed that adolescents from both groups have similar diets, with an intake of food rich in cholesterol, saturated fat, and sodium, greater than those recommended by the III Brazilian Consensus of Blood Hypertension 2, and with low-fiber intake in disagreement with the recommendations for cardiovascular prevention in this age group 27-32.

To conclude, our study identified an unfavorable risk profile among the children of hypertensive parents. New criteria in cardiovascular risk stratification in children and adolescents with greater sensitivity for identifying abnormal pressure and lipid parameters seem relevant. In this context, greater emphasis on the control of risk factors, encouragement of physical activity, as well as the correction of dietary habits from childhood, customized in those with greater risk, may reduce or delay cardiovascular events in adult life.

References

Correspondence to

Francisco Helfenstein Fonseca

Setor de Lípides, Aterosclerose e Biologia Vascular - UNIFESP

Rua Pedro de Toledo, 458

Cep 04039-001 - São Paulo, SP - Brazil

E-mail:

carvalho.dmed@epm.br

Received: 5/15/2002

Accepted: 3/31/2003