Enver Hasanoglu

Prevalence, awareness, treatment and control of hypertension in Turkey (the PatenT study) in 2003.

Objective To determine the distribution of blood pressure (BP) and prevalence, awareness, treatment and control of hypertension in Turkey (PatenT). Design A population-based cross-sectional epidemiology survey was carried out in 2003. Setting Twenty-six cities from seven geographical provinces of Turkey, with proportional representation of urban and rural populations. Participants A two-stage stratified sampling method was used to select a sample of the adult population over 18 years of age. The total number of participants was 4910. Interventions Data collection and BP measurements were conducted by specifically trained physicians in the households of the participants. Main outcome measures The mean systolic and diastolic BP levels, distribution of blood pressure, prevalence of hypertension (mean systolic BP ≥ 140 mmHg or mean diastolic BP ≥ 90 mmHg, or previously diagnosed and/or taking antihypertensive drugs), awareness, treatment and control of hypertension were assessed. Results The overall age-adjusted and sex-adjusted prevalence of hypertension in Turkey was 31.8%, and it was higher in women than in men (36.1 versus 27.5%, P < 0.001). In the whole group, 32.2% had never had their BP measured. Overall, 40.7% of those with hypertension were aware of their diagnosis, only 31.1% were receiving pharmacologic treatment and only 8.1% had their BP under control. The subjects who were aware and treated had a control ratio of 20.7%. Conclusions PatenT data indicate that hypertension is a highly prevalent but inadequately managed health problem in Turkey. There is an urgent need for population-based strategies to improve the prevention, early detection and control of hypertension.

The relationship between hypertension and salt intake in Turkish population: SALTURK study

Abstract This population-based epidemiological study was aimed to evaluate the daily salt intake and its relation to blood pressure in a representative group of Turkish population. The enrolled normotensive and hypertensive individuals (n = 1970) completed a questionnaire including demographics, dietary habits, hypertension awareness and drug usage. Blood pressure was measured and to estimate salt consumption, 24-h urine samples were collected. The daily urinary sodium excretion was 308.3 ± 143.1 mmol/day, equal to a salt intake of 18.01 g/day. Salt intake was higher in obese participants, rural residents, participants with lower education levels and elderly. A positive linear correlation between salt intake and systolic and diastolic blood pressures was demonstrated (r = 0.450, p = 0.020; r = 0.406, p = 0.041; respectively), and each 100 mmol/day of salt intake resulted in 5.8 and 3.8 mmHg increase in systolic and diastolic blood pressures, respectively. Salt intake and systolic blood pressure was significantly correlated in normal weight individuals (r = 0.257, p < 0.01). The Turkish population consumes a great amount of salt; salt intake and blood pressure was positively correlated. Efforts in sodium restriction are therefore crucial in the management of hypertension as part of national and global health policies.

Hypertension incidence in Turkey (HinT): a population-based study.

Objective Hypertension incidence is an important determinant of hypertension prevalence and progression. Few studies have been published on hypertension incidence in developing countries despite the high prevalence observed. The aim of this study was to investigate the incidence of hypertension in Turkey. Methods The study was designed as an epidemiological cohort study which included the population of the Prevalence, awareness, treatment and control of hypertension in Turkey (PatenT) Study which had 4910 volunteers. Blood pressure measurements were performed three times and a questionnaire was used to obtain data on the present status of hypertension with regards to distributions and alterations of risk factors. Results In the present study, 4008 (81.6%) participants of the PatenT Study population were contacted after 4 years. After excluding 173 dead and 67 pregnant individuals, the study cohort comprised of 3768 individuals. The overall 4-year incidence rate of hypertension was 21.4%; it reached a maximum of 43.3% in individuals over 65 years of age. Age, initial blood pressure category, and body mass index were the best predictors of the hypertension incidence rate. Multivariate logistic regression analysis revealed that age, obesity, alcohol consumption, and living in rural areas were significant predictors of hypertension. Conclusion Follow-up periods scheduled considering age, initial blood pressure category, and body mass index are important for the early determination of hypertension. As there are limited data regarding hypertension incidence in developing countries, the results of data collected in this study might serve as a model.

Polymorphisms in the Vitamin D Receptor Gene and the Risk of Calcium Nephrolithiasis in Children

OBJECTIVE Polymorphism in the Vitamin D Receptor (VDR) gene has recently been reported to be associated with calcium metabolism disorders. This study was conducted to investigate the association of VDR gene polymorphism with the risk of calcium nephrolithiasis. METHODS We investigated the VDR ApaI, BsmI and TaqI polymorphisms, in relation to serum calcium, phosphate, intact parathyroid hormone and 1.25(OH)(2)D(3) in 64 hypercalciuric stone-forming children and 90 healthy children. DNA was isolated from peripheral blood, and genotyping was performed with PCR-based methods. RESULTS The frequency of ApaI AA genotype was significantly higher in the children with calcium nephrolithiasis than the controls (chi(2)=9.5; p=0.008). The distribution of BsmI and TaqI genotypes in stone-forming patients was similar to those in the control group. There was a significant association between TaqI TT genotype and the strength of the family history. The patients with TT genotype were observed to have a 8 times more risk than patients with Tt/tt genotype for recurrent stone episodes (OR 8, 95%CI 1.61-39.6). CONCLUSION VDR genotype determination may provide a tool to identify individuals who are at a risk for calcium nephrolithiasis.

Unresponsiveness to Colchicine Therapy in Patients with Familial Mediterranean Fever Homozygous for the M694V Mutation

Objective. More than 50 disease-associated mutations of the Mediterranean fever gene (MEFV) have been identified in familial Mediterranean fever (FMF), some of which were shown to have different clinical, diagnostic, prognostic, and therapeutic implications. The aim of our study was to define the frequency of mutation type, genotype-phenotype correlation, and response to colchicine treatment in patients with FMF. Methods. This study included 222 pediatric FMF patients. All patients were investigated for 6 MEFV mutations. Then patients were divided into 3 groups according to the presence of M694V mutation on both of the alleles (homozygotes), on only 1 allele (heterozygotes), and on none of the alleles, and compared according to their phenotypic characteristics and response to treatment. M694V/M694V was denoted Group A, M694V/Other Group B, and Other/Other, Group C. Results. Complete colchicine response was significantly lower while the rate of unresponsiveness was significantly higher in Group A compared to Groups B and C (p = 0.031, p < 0.001 and p = 0.005, p = 0.029, respectively). No differences except proteinuria were found between the phenotypic features of 3 groups. Group C had the lowest rate of proteinuria development (p = 0.024). All the amyloidosis patients were in Group A. Conclusion. Our results indicate that the M694V/M694V mutation is associated with lower response to colchicine treatment. Therefore, patients homozygous for M694V/M694V may be carrying an increased risk for development of amyloidosis.

Renin-angiotensin system gene polymorphisms: association with susceptibility to Henoch-Schonlein purpura and renal involvement.

The clinical course of Henoch–Schönlein Purpura (HSP) in children is variable, with some patients having a much more rapidly progressing course than others. We investigated whether polymorphisms of the renin–angiotensin system (RAS) genes are involved in HSP. Three RAS genotypes were examined in 114 children with HSP and in 164 healthy children: the angiotensin I converting enzyme (ACE) insertion/deletion polymorphism, the M235T mutation in the angiotensinogen gene (Agt), and the A1166C in the angiotensin II type I receptor (AT1R) gene. Significant differences were observed between HSP patients and control group in the frequency of ACE and Agt genotypes (p=0.004 and p=0.003, respectively). The TT genotype of Agt gene was associated with a 3.5-fold increased risk for Henoch–Schönlein nephritis (HSN) compared with the MM/MT genotype (odds ratio, 3.5; 95% confidence interval, 1.2–10.4). There was a trend to a higher prevalence of the TT genotype of the Agt gene among patients with nephrotic range proteinuria when compared to the patients with mild proteinuria, although the difference did not reach a statistical significance. The results of this study suggest that polymorphisms of ACE gene and Agt gene likely influence the risk of developing HSP. However, among the three genes of the RAS studies, only Agt gene was associated with the susceptibility to HSN. RAS gene polymorphisms studied are not associated with the presence of nephrotic range proteinuria. Additional studies are warranted to verify the correlation between RAS gene polymorphisms and susceptibility to HSP.

Nitric oxide in Henoch-Schönlein purpura.

Objective : To assess the value of nitric oxide (NO) production on the disease activity in children with Henoch-Schönlein purpura (HSP) by measuring serum nitrate levels and urinary nitrate excretion as an indicator for NO production. Methods : The study group consisted of 25 patients and 20 healthy children. We measured serum nitrate, urinary excretion of nitrate, and CRP levels in the acute phase and after remission. Results : Serum nitrate levels in the acute phase of the disease were found to be increased compared to the remission phase (28.67 - 10.3 mmol/l, 14.16 - 2.02 mmol/l) (p<0.001) and the control group (13.15 - 2.28 mmol/l) (p<0.001). Urinary nitrate excretion in the acute phase of the patients (15.32 - 9 mmol/mg) was increased compared to that in the remission phase (8.26 - 4.3 mmol/mg) (p=0.016) and in the control group (7.24 - 4.9 mmol/mg) (p<0.01). Conclusion : Serum NO and urinary nitrate excretion were found to be elevated in patients with HSP and this increase was associated with activation of the disease rather than its severity. These findings suggest a role for NO in the pathogenesis of HSP, but nitric oxide in HSP should be further studied in order to elucidate the pathophysiology of the disease

Desmopressin versus indomethacin treatment in primary nocturnal enuresis and the role of prostaglandins

OBJECTIVES To compare the efficacy of desmopressin and indomethacin and also determine the prostaglandin E2 (PGE2) concentrations in the patient and control groups. METHODS Eighty-five children with primary nocturnal enuresis were followed up for a baseline period of 4 weeks, during which they recorded wet and dry nights. After this period, the patients were divided into three groups that used desmopressin, indomethacin, or placebo for 4 weeks. The dosage of desmopressin (group A, n = 31 ) was 20 microg/day and the dosage of indomethacin (group B, n = 29) was 100 mg/day. The placebo group (group C) consisted of 25 patients. We determined the serum PGE2 and urine PGE2 concentrations before and after treatment in the three groups and in a control group. RESULTS Treatment with desmopressin and indomethacin resulted in significantly more dry nights during the 4 weeks of observation than did placebo (P <0.005). The number of dry nights was also significantly different in the desmopressin group than in the indomethacin group (P <0.01). In the total patient group, the mean serum and urine PGE2 concentrations were significantly different from the control groups serum and urine PGE2 concentrations (P <0.001). There was a significant decrease in the serum and urine PGE2 concentrations in group A and group B after the treatment period (P <0.01). CONCLUSIONS Desmopressin and indomethacin were found to be more effective than placebo. We conclude that prostaglandins have an important role in the pathophysiology of primary nocturnal enuresis.

Sonographic demonstration of intestinal involvement in Henoch-Schönlein syndrome

We evaluated the efficacy of intestinal sonography in the diagnosis of gastrointestinal involvement of Henoch-Schönlein syndrome (HSS). Intestinal sonography was performed in 20 children who were clinically diagnosed as HSS and sonographic findings of the intestinal system were reviewed. Out of 20 patients, 10 who suffered from abdominal pain demonstrated sonographic findings consistent with small intestinal involvement (dilatation of intestinal segments, hypomotility, and eccentric thickening of the intestinal wall). Our results reveal that sonography of the intestine may be useful in the evaluation of the involvement of HSS.

Adiponectin levels and arteriosclerotic risk factors in pediatric renal transplant recipients

Abstract:  ADPN, a recently discovered adipocytokine, has attracted great attention because of its anti‐atherogenic properties. It was suggested as a protective factor for the cardiovascular system because of its close correlation with several risk factors. Our aim was to investigate serum ADPN levels in pediatric RTR and to document possible relationships between ADPN and arteriosclerotic risk factors. Twenty‐one RTR, aged 16.3 ± 4.0 yr, and 23 healthy age and sex‐matched control subjects were enrolled in this study. Serum lipid/lipoprotein fractions, homocysteine and ADPN levels as well as intima‐media thickness of the cIMT were determined in both groups. Significantly higher serum ADPN (p < 0.001) and homocysteine (p < 0.05) levels as well as higher cIMT (p < 0.001) were found in RTR compared with the control subjects, whereas apolipoprotein B and lipoprotein (a) levels were not significantly different. HDL cholesterol was positively correlated with log ADPN (r = 0.585, p < 0.01). There were inverse correlations between log time post‐transplantation and log ADPN as well as HDL cholesterol (r = −0.438, p < 0.05 and r = −0.578, p < 0.05, respectively). There were no correlation between log ADPN, log homocysteine, log apolipoprotein B, lipoprotein (a), creatinine clearance and cumulative steroid dose. Despite reasonable lipid profiles and remarkably elevated ADPN levels, our pediatric RTR with stable graft function displayed a risk for arteriosclerosis because of increased cIMT and mild hyperhomocysteinemia. Regarding the close positive correlation between ADPN and HDL cholesterol, it could be speculated that ADPN is a novel negative surrogate marker of arteriosclerosis. To our knowledge, this is the only report investigating levels and diverse correlates of ADPN in a pediatric RTR group. Further studies in larger groups of recipients are needed to clarify the interaction between arteriosclerotic risk factors and ADPN.