Key result
Higher peripheral systolic BP is linked to greater hemodynamic and arterial impairment in youth.
Why the study?
Arterial changes associated with high blood pressure states in children and adolescents vary depending on arterial type, indexes considered, and blood pressure levels, requiring clarification of gradual structural-functional arterial impairment related to peripheral systolic BP levels or z-scores.
Cross-Sectional (n=1,005)
Pediatric HBP links to graded arterial changes; extends adult data but leaves open prognostic value and intervention thresholds.
BACKGROUND: Arterial changes associated with children and adolescents high blood pressure (HBP) states would vary depending on the arterial type, arterial indexes considered and/or on blood pressure (BP) levels. AIMS: To determine in children and adolescents: 1) if there is gradual structural-functional arterial impairment associated with gradual peripheral (brachial) systolic BP (pSBP) level or z-score increases, and 2) whether subjects with HBP levels and those with normal BP differ in the profiles of arterial changes associated with pSBP deviations. METHODS: 1005 asymptomatic children and adolescents were included. Clinical, anthropometric and arterial non-invasive evaluations were performed. Heart rate, brachial BP, aortic BP and wavederived parameters (i.e. augmentation index), carotid and femoral diameters, blood velocities and elastic modulus, carotid intima-media thickness and aortic pulse wave velocity, were obtained. Two groups were assembled: Reference (without cardiovascular risk factors (CVRFs); n=379) and HBP (n=175). Additionally, subjects were ascribed to groups according to their pSBP z-scores (z-score ≤ 0, 0< z-score < 1 or z-score ≥ 1). Age and sex-related mean and standard deviation equations were obtained for each variable (Reference group). Using those equations, data (entire population) were converted into z-scores. Groups were compared (absolute and z-scored variables) before and after adjusting for cofactors (ANOVA/ANCOVA). Linear regression analyses were done considering: pSBP and z-pSBP (independent) and absolute levels and z-scores for hemodynamic and arterial indexes (dependent variables). Differences in hemodynamic and arterial levels and z-scores variations (dependent) associated with variations in pSBP and z-pSBP (independent variable) were assessed. The slopes of the models for Reference and HBP groups were compared. CONCLUSION: HBP states associate hemodynamic and arterial changes not explained by exposure to other CVRFs, anthropometric or demographic factors. The higher the pSBP deviations from ageand sex-expected mean value in the Reference group, the higher the hemodynamic and arterial indexes deviation. The pSBP-related variations in hemodynamic and arterial indexes would not differ depending on whether HBP states are present or not.
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Zócalo et al. (2018) conducted a cross-sectional in High blood pressure (n=1,005). High blood pressure or increased peripheral systolic blood pressure z-score vs. Normal blood pressure without cardiovascular risk factors was evaluated on Hemodynamic and arterial structural-functional impairment (e.g., aortic BP, augmentation index, IMT, PWV). In 1005 children and adolescents, higher peripheral systolic blood pressure deviations were associated with greater hemodynamic and arterial index deviations, independent of other risk factors.
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