1. High Blood Pressure and Risk Factors in Young Population: How to Manage
Ayrton Pires Brandão
Associate Professor of Cardiology - State University of Rio de Janeiro
President of Brazilian Society of Hypertension
Brazil
Thank you very much Dr.Myers and many thanks also to the organizers of this
meeting for inviting me to be here in this nice Country.
We are going to talk about one topic which is becoming very much actual that is High Blood pressure and other risk factors in Young Population; as the CV Morbi-Mortality is increasing all over the world and there is no doubt that it starts at early ages. Our presentation will contain information from the International literature but also from the Rio de Janeiro Study in development at the State University of Rio de Janeiro since 1983.

2. The Rio de Janeiro Study
School
Home
Hospital
Accordingly, our study was designed as a scholar based-population study involving 7100 Children and adolescents, aged from 6 to 15, both sexes and
three socioeconomic levels. Normal BP curves were designed and comparisons were made among different percentiles. In another moment part of this population was re-examined at their home and also at the hospital together with their parents and siblings. At the hospital a full clinical evaluation was made and part of these results I will be showing to you.
Familial aggregation of CVD and genetic markers are ongoing
Clinical
Evaluation
Stress
Test
Echo
OGTT
and insulin
ABPM
Familial Aggregation of Cardiovascular Risk Factors
Genetic Markers

3. Risk Factors Prevalence Rio de Janeiro Study
Hypertension
14.65
Overweight/Obesity
21.62
Dyslipidemia
39.66
Hyperglicemia
1.44
Hyperinsulinemia
2.3
Smoke
14.88
Sedentarism
59.91
LV geometry alterations
10.47
The prevalence of risk factors in our study is shown here and we can see that sedentarism, dyslipidemia and adiposity are the most prevalent; The association of hypertension, obesity, dyslipidemia, hyperglicemia and hyperinsulinemia are commonly seen in the metabolic syndrome.

4. Blood Pressure Rio de Janeiro Study SBP p<0,001 DBP p<0,001  50
Here we have the distribution of the mean BP values according to their percentiles. You can see that the abnormal percentiles correspond to values like 130/82 for systolic and diastolic, respectively. These figures are those referred as prehypertension on the VII Joint classification
 50
>50 e <95
 95

5. Anthropometric Indexes
Rio de Janeiro Study
Weight p<0,001
BMI p<0,001
Individuals with highest percentiles of blood pressure have the highest values for weight and Body mass index and the contrary can be seen with lowest percentiles. From these data it is clear the aggregation of blood pressure and BMI
 50
>50 e <95
 95

6. Metabolic Variables Log Insulin p<0,02 HDL-c p<0,03
Rio de Janeiro Study
Log Insulin p<0,02
HDL-c p<0,03
On the metabolic variables we can see that the log Insulin has the highest values of insulin in those with highest percentiles of BP and inversely with HDL-c
 50
>50 e <95
 95

7. Oral glucose tolerance test
Rio de Janeiro Study
Glucose * *
* p<0,05 *
Insulin _ _ *
The oral glucose tolerance test clearly showed a significant abnormal response for glucose and insulin for those with highest percentiles of blood pressure * *
Pozzan R et al.
Hypertension, (part 2):

8. Trends of Obesity in Brazil in Two Different Regions18
Northeastern
Southeastern 15 12
Prevalence (%) 9 6
We know that obesity is the central problem in the metabolic syndrome and it has been related more to developed countries. Nevertheless, countries in development and even those underdeveloped are experiencing an unexpected burden of overweight. Look at this example from Brazil. The trends of obesity in 20 years time, in two different regions, show equal increase in prevalence of obesity in both sexes, in spite of having quite different incomes, being northeastern the poorest and southeastern the richest. You can also see that the prevalence of obesity is nearly the same in both areas. 3
Men
Women
Men
Women
1975
1989
1997
Monteiro C. Public Health Nutrition 2002; 5:

9. TRENDS IN THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITION Brazilian old child/adolescents:
On the other hand if you look at children and adolescents pictures in this same area looking for trends in the relative burden of under and over nutrition in twenty years time, we can notice that percentage of under nutrition decreased but the over nutrition increased. It means it moved from one to another problem.
Monteiro C. Public Health Nutrition 2002; 5: