Relationship of body size and body mass to blood pressure: sex-specific and developmental influences.

The relationship of body mass and body fat distribution to blood pressure has been recognized for many years. This relationship has formed the basis for much additional research, including the impact of growth and developmental factors on blood pressure levels. Blood pressure in children is related to somatic growth and is tied to increases in height, skeletal maturation, and sexual maturation. Sexual and ethnic differences in blood pressure levels are already apparent during childhood and may also be related to the process of growth and sexual maturity. Body size exerts a profound influence on a variety of physiological functions, including blood pressure and the onset of sexual maturity. In general, studies have reported a strong linear relationship between height and blood pressure and between body mass and blood pressure such that tracking correlations from childhood to adulthood for both blood pressure and body mass index are significant for most sex and ethnic groups. Studies evaluating the effects of hormone replacement therapy on post-menopausal women have thus far generated results suggesting that the age-related rise of blood pressure is not due directly to hormonal changes associated with menopause. The interrelated effects of growth, maturation, body weight, and body fat are influenced by both genetic and environmental factors. Environmental influences may modify relationships established much earlier, perhaps as early as prenatally, during infancy, or during early childhood. Directions for future research and implications resulting from the complex relationship between body weight and blood pressure are discussed.     

Diagnosis and treatment of low blood pressure in a Canadian community

When some participants in a hypertension screening program reported a previous diagnosis or treatment of low blood pressure a similar program was established at two shopping centres in Montreal to identify and characterize subjects labelled as having low blood pressure. Of the 1019 subjects screened (434 men and 585 women) 275 (27.0%) reported a previous diagnosis of low blood pressure and 278 (27.3%) a previous diagnosis of hypertension. Low blood pressure was significantly more likely to be diagnosed in women than in men. Of the 181 subjects reporting a diagnosis of low blood pressure in the absence of other diagnoses, 69 had received treatment for this condition; fewer than 10 years of education had been completed by 46.4% of the treated subjects and 34.8% of those not treated, compared with 20.0% of the subjects in whom no diagnosis had been made. Assuming that these findings do not reflect an idiosyncrasy of the community or of the population studied, the public and personal health implications of the erroneous diagnosis and treatment of this nondisease need to be assessed.     

A novel method to determine lean body water using localized skin biopsies: correlation between lean skin water and lean body water in an overhydration model

To determine the relationship between total body water (TBW) fraction and local water content measured in the skin (SW) this study assessed eight anesthetized piglets in an overhydration model. TBW was assessed by deuterium oxide dilution and body mass measurements taken throughout the experiments, and by whole body carcass analysis at the end of each experiment. Additionally, extracellular water and plasma volume were assessed using bromide dilution and Evan's blue dilution, respectively. SW was assessed by tissue biopsies taken at 60-min intervals throughout the experiment. Lean body water (LBW) fraction and lean skin water (LSW) fraction were assessed by extracting the fat from the carcass and biopsy samples. A correlation does exist between TBW fraction and SW fraction with r2=0.58 (P<0.05); however, the strongest correlation occurred between the LBW fraction and LSW fraction with r2=0.87 (P<0.05) and an SE of prediction of 0.77%. These data demonstrate that LSW gives an accurate and precise estimate of LBW and could therefore be used to determine the hydration index in appropriate research settings.     

Symptoms of low blood pressure: a population study.

OBJECTIVE--To establish whether an association exists between blood pressures in the "low normal" range and common symptoms such as tiredness, dizziness, headache, and palpitation, as suggested by French and German medical practice but not English or American medical practice. DESIGN--Cross sectional population based survey (the health and lifestyle survey) of blood pressure measurements and self reported common symptoms. Results were analysed by combined stratification and logistic regression. SUBJECTS--7383 (82%) Adults aged 18 and over chosen from the electoral register in England, Wales, and Scotland for the health and lifestyle survey, in whom satisfactory physiological measurements were taken, from 9003 in the interviewed sample. MAIN OUTCOME MEASURES--Body mass index, smoking, social class, exercise, self declared physical illnesses, hours slept, use of drugs, and psychological illness as determined with the general health questionnaire assessed as potential confounders. RESULTS--True confounders were sex, age, taking of drugs, physical illness, exercise, and body mass index. A negative association was found between systolic blood pressure and self reported tiredness and feeling faint, which persisted after adjustment for the confounders. The association was strongest in women aged under 50. A negative association between systolic blood pressure and headache and a positive association between systolic blood pressure and palpitation were explained by confounding by age. CONCLUSIONS--Systemic hypotension is associated with persistent tiredness but treatment is not suggested as either possible or necessary. Instead, low blood pressures may be associated with opposite effects on mortality contrasted with morbidity.     

Segregation analysis of blood pressure and body mass index in a rural US community

To assess evidence for a gene with large effect on systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI), we conducted segregation analyses on 261 nuclear families collected from a rural Caucasian community in Michigan. The families were ascertained through a hypertensive proband. Each phenotype was adjusted for significant covariate effects (e.g., gender and age). We used class D regressive models to conduct the segregation analyses. Our analysis results support the segregation of a major gene for BMI, but not for SBP or DBP. A recessive locus effect provided the best explanation for BMI where approximately 43% of the variance of BMI was due to this gene.     

Relationship of low lean body mass with body weight increase until one year of age and current lifestyles in Japanese young women

To investigate factors affecting the low lean body mass (LBM) of young women, we focused on the increase in body weight until one year of age and current lifestyles. In 442 young women, the increase in body weight from birth until one year of age, breast-feeding method in infancy, current physique index and body composition, and physique and lifestyles were investigated using a questionnaire. Subjects with an LBM percentile of less than 33.3 (less than 36.8 kg) were classified as having a low LBM (n = 150), and those with a 33.3 or higher LBM percentile as the control (n = 293). Based on body weight changes from birth to days 3 and 7, the subjects were divided into a rapid weight gain group and two non-rapid weight gain groups (groups 1-3). To analyze factors involved in a low LBM, multivariate analysis using a logistic model was employed. The prevalence of a low LBM in the rapid weight gain group was 0.41 times higher than in the others. The prevalence of a low LBM with a low birth weight was 0.58 times higher, indicating that a low birth weight is likely to result in a low LBM. Regarding the lifestyles, the prevalence of a low LBM in subjects with a current breakfasting habit was 0.60 times higher than in those without one. These findings suggest that the thinness of young women characterized by a low LBM is associated with the increase in body weight until one year of age and current lifestyles.     

The effect of blood volume loss on cardiovascular response to lower body negative pressure using a mathematical model

Different mathematical models of varying complexity have been proposed in recent years to study the cardiovascular (CV) system. However, only a few of them specifically address the response to lower body negative pressure (LBNP), a stress that can be applied in weightlessness to predict changes in orthostatic tolerance. Also, the simulated results produced by these models agree only partially with experimental observations. In contrast, the model proposed by Melchior et al., and modified by Karam et al. is a simple representation of the CV system capable of accurately reproducing observed LBNP responses up to presyncopal levels. There are significant changes in LBNP response due to a loss of blood volume and other alterations that occur in weightlessness and related one-g conditions such as bedrest. A few days of bedrest can cause up to 15% blood volume loss (BVL), with consequent decreases in both stroke volume and cardiac output, and increases in heart rate, mean arterial pressure, and total peripheral resistance. These changes are more pronounced at higher levels of LBNP. This paper presents the results of a simulation study using our CV model to examine the effect of BVL on LBNP response.     

Biomechanical response of femoral vein to chronic elevation of blood pressure in rabbits

Venous diseases like iliofemoral deep vein thrombosis and valvular dysfunction induce venous hypertension. To know the effects of the hypertension on venous mechanics, blood pressure in the left femoral vein in the rabbit was chronically elevated by the constriction of the left external iliac vein. Wall dimensions and biomechanical properties of the femoral vein were studied in vitro at 1, 2, or 4 wk after surgery. Blood pressure measured immediately before the animal was killed was significantly higher in the left femoral vein than in the sham-operated, contralateral vein. Wall thickness was increased by blood pressure elevation even at 1 wk, which restored circumferential wall stress to a control level. The stress was kept at normal up to 4 wk. Vascular tone and vascular contractility were increased by the elevation of blood pressure; however, wall elasticity and compliance were kept at a normal level. These results are very similar to those observed in hypertensive arteries, indicating that not only arteries but veins optimally operate against blood pressure elevation.     

Impact of chronic exercise training on the blood pressure response to orthostatic stimulation

Exercise training elicits morphological adaptations in the left ventricle (LV) and large-conduit arteries that are specific to the type of training performed (i.e., endurance vs. resistance exercise). We investigated whether the mode of chronic exercise training, and the associated cardiovascular adaptations, influence the blood pressure responses to orthostatic stimulation in 30 young healthy men (10 sedentary, 10 endurance trained, and 10 resistance trained). The endurance-trained group had a significantly larger LV end-diastolic volume normalized by body surface area (vs. sedentary and resistance-trained groups), whereas the resistance-trained group had a significantly higher LV wall thickness and aortic pulse wave velocity (PWV) compared with the endurance-trained group. In response to 60° head-up tilt (HUT), mean arterial pressure (MAP) rose in the resistance-trained group (+6.5 ± 1.6 mmHg, P < 0.05) but did not change significantly in sedentary and the endurance-trained groups. Systolic blood pressure (SBP) decreased in endurance-trained group (-8.3 ± 2.4 mmHg, P < 0.05) but did not significantly change in sedentary and resistance-trained groups. A forward stepwise multiple regression analysis revealed that LV wall thickness and aortic PWV were significantly and independently associated with the MAP response to HUT, explaining ～41% of its variability (R(2) =0.414, P < 0.001). Likewise, aortic PWV and the corresponding HUT-mediated change in stroke volume were significantly and independently associated with the SBP response to HUT, explaining ～52% of its variability (R(2) = 0.519, P < 0.0001). Furthermore, the change in stroke volume significantly correlated with LV wall thickness (r = 0.39, P < 0.01). These results indicate that chronic resistance and endurance exercise training differentially affect the BP response to HUT, and that this appears to be associated with training-induced morphological adaptations of the LV and large-conduit arteries.     

Restless legs syndrome in a 5-year-old boy with low body stores of iron

Restless legs syndrome (RLS) is a common sleep disorder characterized by disagreeable sensations in the legs that occur at rest and are relieved by movement. Little has been reported about pediatric RLS in Asian people. We report the case of a 5-year-old preschooler with RLS, who presented with an uncomfortable sensation in his toes before bedtime and insomnia. Blood tests showed reduced iron stores (serum ferritin, 15.9 ng/mL). The subjective symptoms and a maternal history of RLS were consistent with pediatric RLS. Iron supplement therapy resulted in improvement in the leg sensation and subjective daytime alertness. We recommend detailed evaluation of iron status in preschoolers with suspected RLS.

     

Integration of detailed modules in a core model of body fluid homeostasis and blood pressure regulation

This paper presents a contribution to the definition of the interfaces required to perform heterogeneous model integration in the context of integrative physiology. A formalization of the model integration problem is proposed and a coupling method is presented. The extension of the classic Guyton model, a multi-organ, integrated systems model of blood pressure regulation, is used as an example of the application of the proposed method. To this end, the Guyton model has been restructured, extensive sensitivity analyses have been performed, and appropriate transformations have been applied to replace a subset of its constituting modules by integrating a pulsatile heart and an updated representation of the renin-angiotensin system. Simulation results of the extended integrated model are presented and the impacts of their integration within the original model are evaluated.