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Biomedical subjects

Bonita Falkner

Publications and source records attributed to Bonita Falkner.

At least 19 recordsLinked to original sources
PubMed2006

The relationship of body mass index and blood pressure in primary care pediatric patients.

OBJECTIVE: To determine whether an association of overweight, or risk of overweight, and blood pressure can be detected in children in the pediatric primary care practice setting. STUDY DESIGN: We examined electronic medical record (EMR) data from primary care practices on 18,618 children age 2 to 19 years. Each child was classified on the basis of age- and sex-specific body mass index (BMI) percentile as normal weight (BMI < 85th percentile), at risk for overweight (BMI > or = 85th and < 95th percentile), or overweight (BMI > or = 95th percentile). BMI Z-score and height Z-score were computed. Systolic and diastolic blood pressures were compared among age-sex-BMI groups. RESULTS: Among children in primary care pediatric practices, 16.7% were at risk of overweight and 20.2% were overweight. With increasing BMI status there was a significant increase in both systolic blood pressure (P < .001) and diastolic blood pressure (P < .001). The association of higher blood pressure with increasing BMI status was present in all age groups. CONCLUSIONS: Clinical data from pediatric primary care practices verify the high prevalence of childhood overweight. The effect of overweight on blood pressure is present in childhood and can be detected even in children as young as 2 to 5 years.

Adolescent↗
PubMed2006

Metoprolol succinate, a selective beta-adrenergic blocker, has no effect on insulin sensitivity.

Insulin resistance is a risk factor for cardiovascular disease. Therapies to lower blood pressure should not decrease insulin sensitivity. Some b-adrenergic blocking agents can have an adverse effect on insulin sensitivity. This study examined the effect of extended-release metoprolol succinate on insulin sensitivity. Nondiabetics with hypertension (N=30) were started on (or changed to) hydrochlorothiazide (HCTZ) 12.5 mg daily for 14 days. Patients with blood pressure>140/90 mm Hg while taking HCTZ alone underwent an insulin clamp procedure to quantify insulin sensitivity. Metoprolol succinate treatment was begun at 50 mg daily and titrated to a dose that lowered blood pressure to <140/90 mm Hg. Following 12 weeks of metoprolol succinate plus HCTZ therapy, the insulin clamp procedure was repeated. On metoprolol succinate plus HCTZ treatment, there were no significant changes in insulin clamp measures of insulin sensitivity. Plasma cholesterol and low-density lipoprotein cholesterol decreased significantly on metoprolol succinate plus HCTZ. When b-blocker therapy is considered, metoprolol succinate can be used to treat hypertension without adverse metabolic effects.

Adrenergic beta-Antagonists↗
PubMed2006

The metabolic syndrome--what is it and how should it be managed?

Following a hypertension symposium in Portland, ME, in October 2005, a roundtable was convened to discuss the metabolic syndrome and its significance. Dr. Marvin Moser of the Yale University School of Medicine, New Haven, CT, moderated the discussion. Participating in the discussion were Dr. Bonita Falkner of the Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Dr. Michael A. Weber of SUNY Downstate College of Medicine, New York, NY; and Dr. Leonard Mark Keilson of the University of Vermont College of Medicine.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

Hypertension in children.

Essential, or primary, hypertension is detectable in childhood. Due to the rising rates of childhood obesity, the expression of essential hypertension in childhood is increasing. Despite this trend, the possibility of secondary hypertension should be considered in a child with documented hypertension. Children and adolescents with suspected secondary hypertension may require a more extensive evaluation compared with those expressing characteristics of essential hypertension. Whether the hypertension is determined to be secondary or essential, these children require careful monitoring, interventions to control the blood pressure, and long-term follow-up. Considering the long-term morbidity and mortality associated with essential hypertension, interventions, including preventive interventions, that focus on blood pressure control beginning in the young are an important component of healthcare for children and adolescents.

Adolescent↗
PubMed2005

Effect of obesity and high blood pressure on plasma lipid levels in children and adolescents.

OBJECTIVE: To examine the extent of blood lipid abnormalities in overweight children and to determine whether the prevalence of dyslipidemia is different in overweight children with elevated blood pressure (BP) compared with overweight children with normal BP (NBP). METHODS: A retrospective, case-control study on 497 patients 2 to 18 years of age at the Nemours Weight Management Clinic of duPont Hospital for Children was conducted to compare the prevalence of abnormal plasma lipid levels in overweight children with high BP with overweight children with NBP. RESULTS: Elevated BP was detected in 34.7% of the sample; 27.9% had prehypertension (pre-HTN), and 6.8% had HTN. The rates of abnormal plasma lipid levels were high among overweight children with both NBP and HTN. Significantly more boys with high BP had low high-density lipoprotein cholesterol compared with boys with NBP (49.4% vs 27.6%). Significantly more severely obese boys had low high-density lipoprotein cholesterol compared with moderately obese boys (40.3% vs 29.3%). The prevalence of elevated BP was much greater in severely obese boys and girls (46.5% and 39%) than moderately obese boys and girls (28.1% and 23.1%). CONCLUSIONS: The high prevalence of dyslipidemia found in this overweight sample supports recent recommendations to collect plasma lipid levels in not only overweight children with BP > or =90th percentile but also in all overweight children.

Adolescent↗
PubMed2005

Roundtable discussion: hypertension in children and adolescents.

Following a hypertension symposium held in Philadelphia, PA, on June 8, 2004, a roundtable discussion was held to discuss the treatment of hypertension in adolescents and children. The participants included Thomas D. Giles, MD, of Louisiana State College of Medicine, New Orleans, LA; Bonita Falkner, MD, of the Department of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA; Allan B. Schwartz, MD, of the Division of Nephrology and Hypertension, Drexel University College of Medicine, Philadelphia, PA; Raymond R. Townsend, MD, of the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA; and Marvin Moser, MD, of the Department of Medicine/Cardiology, Yale University School of Medicine, New Haven, CT.

Adolescent↗
PubMed2004

Obesity and high blood pressure: a clinical phenotype for the insulin resistance syndrome in African Americans.

The high prevalence of insulin resistance syndrome in African Americans predisposes this population to higher morbidity and mortality from cardiovascular disease. To test the hypothesis that the combination of obesity and high blood pressure (BP) represents the physical phenotype of insulin resistance syndrome, 337 African-American men and women aged 32+/-4 years were examined and classified into four groups (nonobese-normal BP, nonobese-high BP, obese-normal BP, obese-high BP), according to presence or absence of obesity and high BP. Mean values of glucose, insulin, lipids, urinary albumin excretion, and clamp-derived insulin sensitivity were determined for each group. Prevalence of prediabetes (24.4%), diabetes (19.2%), and insulin resistance syndrome (87.2%) were highest in the obese-high BP group (p<0.001). Mean triglycerides, urinary albumin excretion, fasting glucose, fasting insulin, and insulin resistance were highest in the obese-high BP group (p<0.001). Subjects with both obesity and high BP showed greater expression of lipid and glucose abnormalities, higher urinary albumin excretion, and greater prevalence of prediabetes, undetected type 2 diabetes, and insulin resistance syndrome.

Adult↗
PubMed2004

Relationship of homocysteine with cardiovascular disease and blood pressure.

Elevated plasma homocysteine (Hcy) concentration is considered a risk factor for cardiovascular disease and may also be associated with hypertension. Although links have been established between hyperhomocysteinemia and elevated risk for cardiovascular events, the precise role of plasma Hcy in cardiovascular disease is unclear. Plasma Hcy increases with aging and is associated with other health-related behaviors, including smoking and diet patterns. Both epidemiologic and longitudinal clinical investigations have investigated the possible contribution of plasma Hcy to cardiovascular disease, and most report an association of plasma Hcy with the risk for cardiovascular and cerebral events. Some reports describe a significant relationship between Hcy and blood pressure levels, as well as higher Hcy in hypertensives compared to normotensives. Other studies find that the effect of Hcy disappears following adjustment for other risk factors. Because Hcy cosegregates with other risk factors, it has been difficult to identify an independent effect of Hcy on cardiovascular disease or hypertension. Hcy can be modified to some extent by vitamin supplementation. Hcy reduction may have some benefit in reducing cardiovascular risk in some patients, particularly the elderly. Because the question of an independent role of Hcy on risk for cardiovascular disease has not been determined, the assessment and treatment of Hcy should be approached in the context of other modifiable risk factors.

Cardiovascular Diseases↗
PubMed2004

Race/ethnic issues in obesity and obesity-related comorbidities.

The prevalence of obesity is increasing among all age and racial groups in the United States. There is, however, a disproportionate rise in the prevalence of obesity among African-Americans and Hispanic/Mexican Americans. Obesity is a major contributor to the insulin resistant syndrome (IRS), a condition of multiple metabolic abnormalities that is a precursor to type 2 diabetes, and confers a high risk for cardiovascular events. The estimated prevalence of IRS is also greater in Mexican Americans and African-Americans than in Caucasians. The IRS is identifiable in children, and as with adults, there are racial differences in its expression even at a young age. The obesity-associated diseases, including diabetes and hypertension, are found at higher rates within the minority races compared with Caucasians. However, there are differences, in that obesity-related hypertension occurs at higher rates among African-Americans, and obesity-related diabetes occurs at higher rates among Mexican Americans. Race/ethnic differences in lifestyle behaviors and economic disadvantage may account for some of the race disparity in obesity-related diseases and disease outcomes. Environmental factors, however, do not explain all of the race disparity in disease expression, indicating that there are genetic/molecular factors that are operational as well.

Comorbidity↗
PubMed2003

Effect of birth weight on blood pressure and body size in early adolescence.

The fetal programming theory that birth weight contributes to blood pressure or body size in later life is examined in this study. A prospective longitudinal study was conducted on subjects who were examined as newborns and prospectively interviewed and re-examined at 11 to 14 years old. Low birth weight (<2500 g) was present in 36% of the sample. The adolescent examination included measurements of blood pressure (BP), both auscultation and oscillometric methods; anthropometrics (height, weight, and body mass index [BMI]); health status; and health behaviors. Data were analyzed on 250 subjects. Correlation coefficients of birth weight with all BP measures were nonsignificant, except for the last auscultated diastolic BP (r=0.19, P<0.01), which had a positive relationship. The simple correlation coefficients of birth weight with adolescent body size were significant and positive for weight and BMI. After multiple linear regression analyses with adjustments for age, Tanner stage, and gestational age, there was no significant effect of birth weight on adolescent weight or BMI. No significant correlations were detected for ponderal index at birth with adolescent measures. This study, which includes a substantial portion of low-birth-weight cases (36%), indicates that birth weight does not correlate negatively with later BP. These results do not support the low-birth-weight theory and indicate that childhood factors that are more proximal have a greater effect on adolescent BP than intrauterine factors.

Adolescent↗
PubMed2003

Plasma homocysteine concentration and blood pressure in young adult African Americans.

BACKGROUND: An association of plasma homocysteine concentration ([Hcy]) with cardiovascular events has been described, but the role of [Hcy] in the early phase of cardiovascular disease is uncertain. The purpose of this study was to determine whether [Hcy] is related to blood pressure (BP) or other risk factors in African Americans, a population at high risk for cardiovascular disease. METHODS: This cross-sectional study was conducted on a sample of premenopausal African American women (N = 119) and men (N = 56), 30 to 40 years of age. Each subject was classified as normotensive or hypertensive. Fasting blood samples were obtained for serum lipids, insulin, glucose, Hcy, folate, and B-12, followed by an oral glucose tolerance test. RESULTS: Mean [Hcy] was higher in hypertensives compared to normotensives, but the difference was statistically significant only in women (10.5 +/- 5.3 v 8.2 +/- 2.3; P <.01). In women, the simple correlation analysis revealed a statistically significant relationship of [Hcy] with systolic BP (r = 0.22, P =.02) and diastolic BP (r = 0.240, P =.01). However, after adjusting for age and body mass index (BMI), the correlations were attenuated and no longer significant. There was a significant inverse relationship of [Hcy] with plasma folate (r = -0.35, P <.001) and B-12 (r = -0.29, P <.01) in women. CONCLUSIONS: Although the simple correlation coefficient suggests a significant relationship of [Hcy] with BP in women, this relationship was no longer statistically significant after adjustment for age and BMI. The significant inverse relationship of plasma folate and B-12 with [Hcy] suggest that diet factors may affect the crude [Hcy]-BP relationship identified in this sample.

Adult↗
PubMed2003

Insulin resistance in African Americans.

Hypertension and diabetes mellitus are the leading contributors to end-stage renal disease. African Americans suffer higher rates of renal failure as well as other vascular morbidities associated with hypertension and diabetes. Insulin resistance is strongly associated with hypertension. Insulin resistance is a component of diabetes and also precedes the clinical expression of type 2 diabetes. The relationship of blood pressure with insulin resistance, or impaired insulin action, occurs in African Americans and can be detected at young ages prior to the clinical expression of hypertension or diabetes. Through its relationship with hypertension, diabetes, and hyperlipidemia, insulin resistance is associated with endothelial dysfunction. The interface of insulin resistance with endothelial dysfunction may begin to explain the role of insulin resistance in vascular and renal pathology. The injury process, subsequent to both hypertension and diabetes, appears to be mediated by alterations tissue regulatory factors, and include vasoactive peptides such as angiotensin II, endothelin, and growth factors. Understanding the determinants that up-regulate the aberrant pathways and the early phases of these processes will be necessary to formulate strategies to effectively achieve renal protection and reduce the rates of renal failure in African Americans.

Black or African American↗
PubMed2002

Birth weight as a predictor of future hypertension.

According to the concept of "fetal programming," intrauterine conditions that impair fetal growth can program the fetus to express hypertension, as well as other chronic diseases, in later life. A model for the development of hypertension that includes the effect of the intrauterine environment on fetal growth as a mechanistic pathway contributes a new dimension in causality and is of great interest. Experimental studies that apply maneuvers to impose fetal undernutrition in animal models have developed data that support this concept. The evidence developed from epidemiologic investigations on humans is less conclusive. Overall, there tends to be a small but consistent relationship of lower birth weight with higher blood pressure (BP). For each kilogram increase in birth weight, the systolic BP is 1 to 2 mm Hg lower.

Birth Weight↗
PubMed2002

Glucose tolerance and cardiovascular risk in young adult African Americans.

BACKGROUND: Patients with type 2 diabetes have higher rates of cardiovascular events. Among African Americans, there is a higher prevalence of both cardiovascular disease and type 2 diabetes. Few studies have examined longitudinally the change in glucose tolerance in younger adult African Americans. METHODS: To examine the longitudinal relationship of glucose tolerance with other cardiovascular risk factors, 30 African American men and women aged 20 to 43 years were examined twice at an interval of 4 to 5 years. Cardiovascular risk factors, glucose tolerance, and insulin sensitivity (determined from euglycemic hyperinsulinemic clamp procedure) were assessed at each examination. Known diabetics were excluded from initial enrollment. The relationship of glucose tolerance status (normal, impaired, or diabetic glucose tolerance) to body mass index, blood pressure, cholesterol, and insulin sensitivity were further investigated. RESULTS: Initial oral glucose tolerance test identified 24 of 130 (18.5%) subjects with impaired glucose tolerance and 2 of 130 (1.5%) subjects with diabetes. Of the remaining 104 subjects with normal glucose tolerance, subsequent 5-year examination detected 31 (29.8%) with impaired glucose tolerance and 5 (4.8%) with diabetes. Those who later developed diabetes had higher mean systolic blood pressure (133 versus 121, P = 0.037) at exam 1. By exam 2, those with abnormal glucose tolerance had worse cardiovascular risk profiles and increased insulin resistance (P < 0.001). CONCLUSION: Conversion to abnormal glucose tolerance is relatively frequent in young adult African Americans. Deterioration in glucose tolerance may be preceded by higher systolic blood pressure and is accompanied by worsening of other cardiovascular risk factors and insulin resistance.

Adult↗
PubMed2002

Dysmetabolic syndrome: multiple risk factors for premature adult disease in an adolescent girl.

The clinical diagnosis of dysmetabolic syndrome in an adult defines a patient with abnormal glucose metabolism (or diabetes), hypertension, hyperlipidemia, and obesity. This disorder accelerates atherosclerosis and significantly raises the risk for cardiovascular events. With the marked rise in the prevalence of obesity in childhood, obesity-linked risk factors are being expressed at young ages. The case of a 12-year-old girl with dysmetabolic syndrome is described and discussed. Emerging clinical data now indicate that the presence of 1 risk factor for cardiovascular disease in an overweight child should prompt screening for additional clinical abnormalities, with the aim of finding treatable disorders.

Adolescent↗