[Vasoactive peptides, endothelin 1 and neuropeptide Y, and total peripheral vascular resistance in children with essential hypertension]. / Stezenie wazoaktywnych peptydów endoteliny 1 i neuropeptydu Y a calkowity obwodowy opór naczyniowy u dzieci z samoistnym nadcisnieniem tetniczym.

Cardiac function was evaluated in rest and after exercise on a cycloergometer in 20 patients with essential hypertension (EH) aged 14 to 19 years and 12 age-matched healthy volunteers. Selected parameters of ECHO examination and mitral flow were assessed, including SV, CO, CI, %SF, EF, LIVDd, IVSd, LVPWd, LVMI, total peripheral vascular resistance, ESS, velocity of wave E. A and E/A index. In all cases, serum ET1 and NPY levels were measured in rest and after exercise, before and after 6-month enalapril therapy. The ETI serum level in hypertensive patients did not differ from controls, while the NPY level was significantly higher in hypertensives. Exercise did not affect the ETI serum concentration, however, it did increase the NPY level. Enalapril therapy had no effect on serum peptide concentrations. Correlation of the ETI serum level with ECHO parameters, including CO, Cl, SV, LIVDd, LVPWd, %SF, TPRI and wave E velocity, as well as correlation of NPY concentration with LIVDd, LVPWd, LVMI, ESS and wave E and A velocity may suggest that these peptides influence left ventricle function and structure disturbances in children with EH.

[Molecular markers of hemostasis activation in children with nephrotic syndrome]. / Molekularne markery aktywacji hemostazy u dzieci z zespolem nerczycowym.

Vein and arterial thrombosis is a rather rare but potentially life-threatening complication of nephrotic syndrome (n.s.). None of the specific markers of hypercoagulability state in n.s. have been identified. The aim of the study was to estimate plasma parameters of prothrombic state in children with n.s. Ten children aged from 3 to 10 yrs (mean 5.7 +/- 2.5) with recurrence of n.s. and 10 healthy controls matched for age and sex were studied. In all children with n.s. prothrombin fragments F 1+2, D-dimers (D-d), thrombin-antithrombin III complexes (TAT) and whole blood clotting time thrombin time, prothrombin time, plasma fibrinogen and platelet count were determined in the hypovolemic state (before therapy was started), in the normovolemic state (after plasma expander was used) and in the course of anticoagulation treatment (two week dicumarol therapy). In comparison with healthy controls all children with recurrence of n.s. in the hypovolemic state showed a significant (p < 0.05) increase of D-d (910 vs 500 ng/ml), TAT (14.26 vs 2.6 ng/ml), F 1+2 (5.68 vs 0.79 nmol/l), plasma fibrinogen (592 vs 272 mg/dl), platelet count (632 vs 275 x 10(9)/l) and shortening of WBCT (30.0 vs 35 s). Plasma volume expansion produced by dekstran was followed by a moderate decrease of all parameters. Two-week anticoagulant treatment had no impact on estimated haemostasis parameters.

[Evaluation of the efficacy and safety of monotherapy for significant essential hypertension in adolescents with use of enalapril]. / Ocena skutecznosci i bezpieczenstwa monoterapii znamiennego nadcisnienia tetniczego u mlodziezy przy zastosowaniu enalaprylu.

Clinical evaluation of hypotensive effectiveness and the cardiovascular and side effects of enalapril monotherapy of significant essential hypertension (SEH) in adolescents was performed. The studied group included 30 pts., aged from 12 to 18 years. The mean enalapril dose was 0.22 mg/kg/24 hours. Significant decrease of systolic, diastolic and mean arterial blood pressure was observed. ECHO examination performed after 6 months of therapy demonstrated significant decrease of intraventricular septum thickness, cardiac index and percentage of LV fractional shortening. Only a few minor side effects involving the GI tract were observed during therapy. We conclude that enalapril monotherapy is effective in adolescents with SEH and exerts a beneficial influence on sodium and purine balance and no adverse effect on the lipid profile. It can therefore be safely used in hypertensive patients with hyperuricemia and hypercholesterolemia. It causes regression of LV hypertrophy and improves exercise capacity.

[Arterial hypertension as a complication of homocystinuria in a 14-year old boy]. / Nadcisnienie tetnicze jako powiklanie homocystynurii u 14-letniego chlopca.

A boy with homocystinuria diagnosed at the age of fourteen during arterial hypertension diagnostic procedures performed because of severe arterial hypertension. Hypertension was caused by thromboembolic changes within segmental branch of renal artery.

[Evaluation of the efficacy and tolerance of three antihypertensive agents used as single-drug therapy, nifedipine, prazosin and acebutolol in severe, idiopathic hypertension in adolescents]. / Evaluation de l'efficacité et de la tolérance de trois antihypertenseurs utilisés en monothérapie, nifédipine, prazosin et acébutolol dans l'hypertension idiopathique grave de l'adolescent.

The antihypertensive efficacy of single-drug therapy with nifedipine (N), prazosin (P), or acebutolol (A) and the influence of these agents on coronary risk factors including hypoglycemia, hyperuricemia, and hyperlipidemia, were studied in adolescents with hypertension. Ninety patients (73 girls and 17 boys) aged 14 to 18 years with idiopathic hypertension (IH) were randomized into three groups. Each group received N, P, or A as single-drug therapy for six months. Systolic and diastolic blood pressures fell in all three groups, from 152/90 mmHg to 127/70 mmHg* with N, from 150/90 mmHg to 121/70 mmHg* with P, and from 148/92 mmHg to 122/74 mmHg* mmHg with A. In 17% of cases, N failed to reduce blood pressures below the 90th centiles. Heart rate was not influenced by N or P but decreased from 84 to 75 bpm with A. Although none of the drugs modified serum uric acid levels, fractional uric acid secretion rose with P and A (from 4.1% to 6% with P; and from 4.4% to 6% with A). The lipid profile remained unchanged under N and P, whereas a decrease in serum LDL-cholesterol from 99.6 to 88.8% mg* was seen with A. Fasting serum glucose levels increased from 86.4 to 92.7 mg %* in the group given A. N, P, and A are suitable for single-drug therapy of IH in adolescents; the most appropriate drug should be selected on the basis of medical history.

A single pediatric center experience with 1025 children with hypertension.

Between January 1982 and December 1989 1025 patients aged between one month and 18 years with increased blood pressure were referred for evaluation. Borderline hypertension was found in 389 children; 636 had sustained significant hypertension. In 351 patients, hypertension was secondary to a known disease. Renal parenchymal diseases were present in 68% of patients while renovascular and endocrine disorders were found in 10% and 11%, respectively. Of the 258 children aged less than 15 years, all but six children had known causes of hypertension, while 75% of adolescents had essential hypertension. In the 389 children with borderline hypertension, 65% developed fixed hypertension over a period of 2-3 years.