Influência da distribuiçäo da gordura corporal sobre a prevalência de hipertensäo arterial e outros fatores de risco cardiovascular em indivíduos obesos; Influence of …

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POSTERS: Obesity, Insulin Resistance, Diabetes

and microalbuminuria, the cardiovascular status by clinical and laboratory tests, and measured plasma glucose, insulin, and C-peptide levels at fast and following a 75-g oral glucose tolerance test (OGTT). Patients with creatinine clearance less than 30 ml/min/1.73 m2, severe hypertension, obesity, and diabetes or family history of diabetes were excluded. Hypertensive patients had significantly greater fasting plasma insulin and C-petide levels and glucose and insulin responses to OGTT as compared to normotensive controls. In 116 of 321 hypertensive patients we found creatinine clearance less than 90 ml/min/1.73 m2, which was caused by hypertensive nephrosclerosis. Analysis of patients with different degree of renal function impairment demonstrated increased plasma glucose response to OGTT, hyperinsulinemia, and decreased fasting glucose/insulin ratio only in those patients with creatinine clearance less than 50 ml/min/1.73 m2. Parameters of glucose metabolism were not correlated with creatinine clearance and microalbuminuria. Prevalence of atherosclerotic cardiovascular events was significantly related to reduction of creatinine clearance, but parameters of glucose metabolism were comparable in patients with and without evidence of atherosclerotic damage. Thus, in patients with hypertensive nephrosclerosis and early impairment of glomerular filtration, alterations of glucose metabolism become evident only when creatinine clearance is less than 50 ml/min/1.73 m2 and do not seem to be related to microalbuminuria and cardiovascular complications. Key Words: nephroangiosclerosis, glucose metabolism, microalbuminuria

P-593 INFLUENCE OF BODY FAT DISTRIBUTION ON THE PREVALENCE OF HYPERTENSION AND BLOOD PRESSURE IN OBESE WOMEN Frida L. Plavnik, Glaucia Carneiro, Alessandra Faria, Fernando F. Ribiero Filho, Daniel Lerario, Sandra Roberta Ferreira, Maria Teresa Zanella. 1Nephrology, Kidney and Hypertension Hospital, Sao Paulo, Sao Paulo, Brazil, 2 Endocrinology, EPM - UNIFESP, Sao Paulo, Sao Paulo, Brazil Obesity predisposes to abnormalities in lipid profile, glucose intolerance and hypertension (HT). To asses the influence of abdominal fat on blood pressure (BP), 229 women, mean age of 37[⫹-]16 years and body mass index (BMI) of 37,5[⫹-]6.8kg/m2 were studied Patients were considered to be hypertensive when systolic and/or diastolic (SBP/DBP) values were equal or higher than 140/90 mmHg, or lower if on antihypertensive (AHT) medication. Of the 229, 139 were HT (60.7%). The prevalence of HT increased with BMI from 25% (BMI 25 to 29,9 kg/m2) to 76% (BMI ⱖ40) and also with the Waist/Hip ratio (WHR), from 39,4% (WHR ⬍0.88) to 61% ( WHR ⬎0.95). Patients with obesity class 1 and 2 (BMI 30-34.9 and 35-39.9kg/m2), showed higher frequency of HT when those with WHR ⬎0.95 e ⬍0.88 were compared (75%vs37.5% and 81.8% vs 39.3%; p⬍0.05). A correlation was found between the waist circunference and the SBP (r⫽0.35; p⬍0.001). Also, HT patients with WHR ⬎ 0.95 showed SBP higher than those with WHR⬍0,88 (159[⫹]21vs141[⫹-]24 mmHg, p⬍0.05) while normotensives did not differ (122[⫹-]8 vs 119[⫹-]9 mmHg).In conclusion, abdominal fat distribution predisposes to higher prevalence of hypertension and higher BP levels in hypertensive patients. Key Words: body fat distribution, hypertension, obesity

P-594 EFFECTS OF WEIGHT REDUCTION WITH ORLISTAT ON CARDIOVASCULAR RISK IN OBESE HYERTENSIVE PATIENTS WITH TYPE 2 DIABETES Marcelo H. Uehara, Ricardo B. Peres, Sandra Roberta Ferreira, Maria Teresa Zanella. 1Nephrology, Kidney and Hypertnsion Hospital, Sao Paulo, Sao Paulo, Brazil, 2 Endocrinology, UNIFESP-EPM, Sao Paulo, Sao Paulo, Brazil Most of the type 2 diabetic (DM2) patients also present obesity, dislipidemia and hypertension and are at high risk for cardiovascular (CV)

AJH–April 2001–VOL. 14, NO. 4, PART 2

disease. In this study, the benefits of weight reduction on CV risk was examined in 13 hypertensive patients with uncontrolled DM2, who were treated during three months with a low calorie diet and the lipase inhibitor orlistat (120mg t.i.d.).The CV risk was calculated according to the American Heart Association CV risk (AHAcvr) score table, both before and after treatment. Body mass index and the percentage of body fat evaluated by bioimpedance decreased from 32.7[⫹-]3.5 to 31.1[⫹]3.6 kg/m2 (p⬍0.05) and from 40[⫹-]6% to 37[⫹-]5 % (p⬍0.05) respectively. The waist circumference was reduced from 104[⫹-]11 to 100[⫹-]13 cm (p⬍0.05) Fasting serum glucose fell from 257[⫹-]76 to 184[⫹-]69 mg/dl (FG) (p⬍0.05), and a correlation was found between changes in BW and FG (r⫽ 0.52; p⫽0.06). Lipid profile did not alter, while diastolic blood pressure decreased from 89[⫹-]10 to 83[⫹-]7 mmHg (p⫽0.06). Altogether, the therapy resulted in a reduction in AHAcvr from 33,5[⫹-]5 to 29,2[⫹-]6,5 (p⬍0.05). Our results indicate that the weight loss observed with orlistat is effective to reduce CV risk in DM2 patients. Key Words: diabetes, obesity, hypertension

P-595 IMPAIRED ␣2-ADRENERGIC AGONIST-INDUCED VASORELAXATION IN FRUCTOSE-FED RATS Yoshitoki Takagawa, Morris E. Berger, Michael L. Tuck, Michael S. Golub. 1Division of Endocrinology, Department of VA Greater Los Angeles Health Care System, Sepulveda, CA, United States,2Departement of Medicine, UCLA School of Medicine, Los Angeles, CA, United States To investigate the significance of the duration of the insulin resistance state on endothelium-dependent vascular reactivity, muscarinic and ␣2adrenergic receptor-mediated relaxations in small mesenteric arteries were studied in the fructose-fed rat, a model of the insulin resistance syndrome. Male Sprague-Dawley rats were fed either 60 % fructose (FFR) or normal chow as control (CNT) for 8 and 40 weeks. Systolic blood pressure (SBP) was measured periodically by the tail-cuff method. At the end of each study period, arterial blood samples were taken from the abdominal aorta for measurements of plasma triglyceride (TG), glucose and insulin. A 3 mm segment of tertiary branch of the mesenteric artery (250-300 ␮m in internal diameter) was cannulated with micropipettes and pressurized to 40 mm Hg. The artery was then treated with prazosin (10-6 M) and propranolol (3’ 10-6 M) for one hour. Relaxation was induced by cumulative addition of acetylcholine (ACh, 10-9-10-4 M), or a selective ␣2-agonist B-HT 920 (10-9-10-5 M) to arteries preconstricted by serotonin (5-HT, 10-6 M). SBP in FFR was significantly higher than that in CNT at several points after 12 weeks of fructose feeding. TG was higher in FFR than in CNT (p⬍0.01) and similar between 8 and 40 weeks. Insulin and glucose were significantly (p⬍0.01) higher at 40 weeks than at 8 weeks in FFR but not in CNT, while insulin/glucose (I/G) ratio were comparable between 8 and 40 weeks. At 40 weeks, the insulin and I/G ratio were significantly increased in FFR compared to CNT, however, at 8 weeks, the insulin and I/G ratio in FFR were higher but not significantly versus CNT. Plasma glucose was similar between the two groups at 8 and 40 weeks. Maximum relaxations to ACh at 8 weeks (91⫾12 % in FFR vs. 95⫾4 % in CNT) were well maintained at 40 weeks (89⫾9 % in FFR vs. 94⫾ 4 % in CNT) and similar between FFR and CNT. However, the sensitivity to ACh (ED50 [log M]) was significantly (p⬍0.01) reduced in FFR (-6.8⫾0.4) compared to CNT (-7.6⫾0.4) at 40 weeks but not at 8 weeks (-7.7⫾0.4 in FFR vs. -7.7⫾ 0.3 in CNT). B-HT 920-induced relaxation was less in FFR than in CNT (p⬍0.05) at 8 (30⫾10 % vs. 41⫾ 15% at 10-5 M) and 40 (19⫾14 % vs. 36⫾ 10 % at 10-5 M) weeks. In conclusion, ␣2adrenergic receptor-mediated endothelium-dependent vascular relaxation was already impaired by short-term fructose feeding prior to blood pressure elevation and insulin resistance. On the other hand, impaired