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High Central Aortic Rather than Brachial Blood Pressure is Associated with Carotid Wall Remodeling and Increased Arterial Stiffness in Childhood

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Abstract

Introduction

In adults, central blood pressure (cBP) is reported to associate target organ damages (TODs) rather than peripheral blood pressure (pBP). However, data regarding the association of pre-clinical TODs with cBP and pBP in pediatric populations are scarce.

Aim

To evaluate in children and adolescents the importance of cBP and pBP levels, in terms of their association with hemodynamic and vascular changes.

Methods

315 subjects [age (mean/range) 12/8–18 years] were included. Measurements: pBP (oscillometry, Omron-HEM433INT and Mobil-O-Graph), cBP levels and waveforms (oscillometry, Mobil-O-Graph; applanation tonometry, SphygmoCor), aortic wave reflection-related parameters, carotid intima-media thickness (CIMT) and carotid (elastic modulus, stiffness-index) and aortic stiffness (carotid-femoral pulse wave velocity, PWV). Four groups were defined considering pBP and cBP percentiles (th): cBP ≥90th, cBP <90th, pBP ≥90th, pBP <90th. In each group, haemodynamic and vascular parameters were compared for subgroups defined considering the level of the remaining blood pressure (cBP or pBP). Subgroups were matched for anthropometric and cardiovascular risk factors (propensity matching-score).

Results

Subjects with high cBP showed a worse cardiovascular risk profile in addition to worse peripheral hemodynamic conditions. The CIMT, carotid and aortic stiffness levels were also higher in those subjects. CIMT and carotid stiffness remained statistically higher when subjects were matched for pBP and other cardiovascular risk factors. There were no differences in arterial properties when subjects were analyzed (compared) considering similar pBP levels, during normal and high cBP conditions.

Conclusion

Compared with pBP, the cBP levels show a greater association with vascular alterations (high CIMT and arterial stiffness), in children and adolescents.

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References

  1. Raitakari OT, Juonala M, Kähönen M, Taittonen L, Laitinen T, Mäki-Torkko N, Järvisalo MJ, Uhari M, Jokinen E, Rönnemaa T, Akerblom HK, Viikari JS. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA. 2003;290(17):2277–83.

    Article  CAS  PubMed  Google Scholar 

  2. Juhola J, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, Srinivasan SR, Daniels SR, Davis PH, Chen W, Kähönen M, Taittonen L, Urbina E, Viikari JS, Dwyer T, Raitakari OT, Juonala M. Combined effects of child and adult elevated blood pressure on subclinical atherosclerosis: the International Childhood Cardiovascular Cohort Consortium. Circulation. 2013;128(3):217–24.

    Article  PubMed  Google Scholar 

  3. Oikonen M, Nuotio J, Magnussen CG, Viikari JS, Taittonen L, Laitinen T, Hutri-Kähönen N, Jokinen E, Jula A, Cheung M, Sabin MA, Daniels SR, Raitakari OT, Juonala M. Repeated blood pressure measurements in childhood in prediction of hypertension in adulthood. Hypertension. 2016;67(1):41–7.

    Article  CAS  PubMed  Google Scholar 

  4. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinicalcar diovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007;115(4):459–67.

    Article  PubMed  Google Scholar 

  5. Expert Panel on Integrated Guidelines for Cardiovascular Health, and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128(Suppl 5):S213–56.

    Google Scholar 

  6. Urbina EM, Williams RV, Alpert BS, Collins RT, Daniels SR, Hayman L, Jacobson M, Mahoney L, Mietus-Snyder M, Rocchini A, Steinberger J, McCrindle B, American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Noninvasive assessment of subclinical atherosclerosis in children and adolescents: recommendations for standard assessment for clinical research: a scientific statement from the American Heart Association. Hypertension. 2009;54(5):919–50.

    Article  CAS  PubMed  Google Scholar 

  7. Kollias A, Lagou S, Zeniodi ME, Boubouchairopoulou N, Stergiou GS. Association of central versus brachial blood pressure with target-organ damage: systematic review and meta-analysis. Hypertension. 2016;67(1):183–90.

    Article  CAS  PubMed  Google Scholar 

  8. McEniery CM, Cockcroft JR, Roman MJ, Franklin SS, Wilkinson IB. Central blood pressure: current evidence and clinical importance. Eur Heart J. 2014;35(26):1719–25.

    Article  PubMed  PubMed Central  Google Scholar 

  9. McEniery CM, McDonnell B, Munnery M, Wallace SM, Rowe CV, Cockcroft JR, Wilkinson IB, Anglo-Cardiff Collaborative Trial Investigators. Central pressure: variability and impact of cardiovascular risk factors: the Anglo-Cardiff Collaborative Trial II. Hypertension. 2008;51(6):1476–82.

    Article  CAS  PubMed  Google Scholar 

  10. Bia D, Zócalo Y, Farro I, Torrado J, Farro F, Florio L, Olascoaga A, Brum J, Alallón W, Negreira C, Lluberas R, Armentano RL. Integrated evaluation of age-related changes in structural and functional vascular parameters used to assess arterial aging, subclinical atherosclerosis, and cardiovascular risk in Uruguayan adults: CUiiDARTE project. Int J Hypertens. 2011;2011:587303. doi:10.4061/2011/587303.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Curcio S, García-Espinosa V, Arana M, Farro I, Chiesa P, Giachetto G, Zócalo Y, Bia D. Growing-related changes in arterial properties of healthy children, adolescents, and young adults non-exposed to cardiovascular risk factors: analysis of gender-related differences. Int J Hypertens. 2016;2016:4982676. doi:10.1155/2016/4982676.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. García-Espinosa V, Curcio S, Castro JM, Arana M, Giachetto G, Chiesa P, Zócalo Y, Bia D. Children and adolescent obesity associates with pressure-dependent and age-related increase in carotid and femoral arteries’ stiffness and not in brachial artery, indicative of non-intrinsic arterial wall alteration. Int J Vasc Med. 2016;2016:4916246. doi:10.1155/2016/4916246.

    PubMed  PubMed Central  Google Scholar 

  13. Castro JM, García-Espinosa V, Curcio S, Arana M, Chiesa P, Giachetto G, Zócalo Y, Bia D. Childhood obesity associates haemodynamic and vascular changes that result in increased central aortic pressure with augmented incident and reflected wave components, without changes in peripheral amplification. Int J Vasc Med. 2016;2016:3129304. doi:10.1155/2016/3129304.

    PubMed  PubMed Central  Google Scholar 

  14. Szer G, Kovalskysa I, De Gregorio MJ. Prevalence of overweight and obesity, and their relation to high blood pressure and central adiposity in students. Arch Argent Pediatr. 2010;108(6):492–8.

    PubMed  Google Scholar 

  15. National High Blood Pressure Education Program Working Group in High Blood Pressure in Children and Adolescents. The Fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2):555–76.

    Article  Google Scholar 

  16. Wei W, Tölle M, Zidek W, van der Giet M. Validation of the mobil-O-Graph: 24 h-blood pressure measurement device. Blood Press Monit. 2010;15(4):225–8.

    Article  PubMed  Google Scholar 

  17. Weber T, Wassertheurer S, Rammer M, Maurer E, Hametner B, Mayer CC, Kropf J, Eber B. Validation of a brachial cuff-based method for estimating central systolic blood pressure. Hypertension. 2011;58(5):825–32.

    Article  CAS  PubMed  Google Scholar 

  18. Wassertheurer S, Kropf J, Weber T, van der Giet M, Baulmann J, Ammer M, Hametner B, Mayer CC, Eber B, Magometschnigg D. A new oscillometric method for pulse wave analysis: comparison with a common tonometric method. J Hum Hypertens. 2010;24(8):498–504.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Hametner B, Wassertheurer S, Kropf J, Mayer C, Eber B, Weber T. Oscillometric estimation of aortic pulse wave velocity: comparison with intra-aortic catheter measurements. Blood Press Monit. 2013;18(3):173–6.

    Article  PubMed  Google Scholar 

  20. Boutouyrie P, Fliser D, Goldsmith D, Covic A, Wiecek A, Ortiz A, Martinez Castelao A, Lindholm B, Massy ZA, Suleymanlar G, Sicari R, Gargani L, Parati G, Mallamaci F, Zoccali C, London GM. Assessment of arterial stiffness for clinical and epidemiological studies: methodological considerations for validation and entry into the European Renal and Cardiovascular Medicine registry. Nephrol Dial Transplant. 2014;29(2):232–9.

    Article  PubMed  Google Scholar 

  21. Elmenhorst J, Hulpke-Wette M, Barta C, DallaPozza R, Springer S, Oberhoffer R. Percentiles for central blood pressure and pulse wave velocity in children and adolescents recorded with an oscillometric device. Atherosclerosis. 2015;238(1):9–16.

    Article  CAS  PubMed  Google Scholar 

  22. Doyon A, Kracht D, Bayazit AK, Deveci M, Duzova A, Krmar RT, Litwin M, Niemirska A, Oguz B, Schmidt BM, Sözeri B, Querfeld U, Melk A, Schaefer F, Wühl E, 4C Study Consortium. Carotid artery intima-media thickness and distensibility in children and adolescents: reference values and role of body dimensions. Hypertension. 2013;62(3):550–6.

    Article  CAS  PubMed  Google Scholar 

  23. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70:41–55.

    Article  Google Scholar 

  24. Thoemmes F, Kim ES. A systematic review of propensity score methods in the social sciences. Multivar Behav Res. 2011;46:90–118.

    Article  Google Scholar 

  25. Eng J. Sample size estimation: how many individuals should be studied? Radiology. 2003;227(2):309–13.

    Article  PubMed  Google Scholar 

  26. Fernhall B, Agiovlasitis S. Arterial function in youth: window into cardiovascular risk. J Appl Physiol (1985). 2008;105(1):325–33.

  27. Falkner B, Daniels SR. Summary of the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Hypertension. 2004;44(4):387–8.

    Article  CAS  PubMed  Google Scholar 

  28. Falkner B. Recent clinical and translational advances in pediatric hypertension. Hypertension. 2015;65(5):926–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM, Ali T, Umans JG, Howard BV. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension. 2007;50(1):197–203.

    Article  CAS  PubMed  Google Scholar 

  30. Jung CH, Jung SH, Kim KJ, Kim BY, Kim CH, Kang SK, Mok JO. Differential associations of central and brachial blood pressure with carotid atherosclerosis and microvascular complications in patients with type 2 diabetes. BMC Cardiovasc Disord. 2014;14:23.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, Hughes AD, Thurston H, O’Rourke M, CAFE Investigators; Anglo-Scandinavian Cardiac Outcomes Trial Investigators; CAFE Steering Committee and Writing Committee. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006;113(9):1213–25.

    Article  CAS  PubMed  Google Scholar 

Download references

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Author notes

    Authors and Affiliations

    1. Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800, Montevideo, Uruguay

      Gonzalo Peluso, Victoria García-Espinosa, Santiago Curcio, Marco Marota, Juan Castro, Daniel Bia & Yanina Zócalo

    2. Basic Medicine Department, School of Medicine, Clinical Hospital, Republic University, Avenida Italia w/n, 11600, Montevideo, Uruguay

      Marco Marota

    3. Pediatric Cardiology Department, Pediatric Hospital Center Pereira-Rossell, ASSE, Ministry of Public Health, Boulevard Artigas 1550, 11600, Montevideo, Uruguay

      Pedro Chiesa

    4. Pediatric Clinic “C”, School of Medicine, Republic University, Pediatric Hospital Center Pereira-Rossell, ASSE, Ministry of Public Health, Boulevard Artigas 1550, 11600, Montevideo, Uruguay

      Gustavo Giachetto

    Authors
    1. Gonzalo Peluso
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    2. Victoria García-Espinosa
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    9. Yanina Zócalo
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    Corresponding author

    Correspondence to Yanina Zócalo.

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    Funding

    This work was supported by the Agencia Nacional de Investigación e Innovación (ANII) and Espacio Interdisciplinario (EI) and Comisión Sectorial de Investigación Científica (CSIC-Udelar) of the Republic University, Uruguay. Additionally, this work was supported by extrabudgetary funds generated by CUiiDARTE Centre and Project.

    Conflict of interest

    Author Gonzalo Peluso declares that he has no conflict of interest. Victoria García declares that she has no conflict of interest. Santiago Curcio declares that he has no conflict of interest. Marco Marotta declares that he has no conflict of interest. Juan M. Castro declares that he has no conflict of interest. Dr. Pedo Chiesa declares that he has no conflict of interest. Dr. Gustavo Giachetto declares that he has no conflict of interest. Dr. Daniel Bia declares that he has no conflict of interest. Dr. Yanina Zócalo declares that she has no conflict of interest.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The protocol of this project was accepted by the Ethics Committee of our Institution.

    Informed consent

    Informed consent was obtained from all individual participants included in the study. Children’s Responsible adults gave their signed consents in order to participate with this study and allow the information to be used as investigation ending.

    Additional information

    Gonzalo Peluso, Daniel Bia and Yanina Zócalo contributed equally to this work. Daniel Bia and Yanina Zócalo are CUiiDARTE Directors.

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    Peluso, G., García-Espinosa, V., Curcio, S. et al. High Central Aortic Rather than Brachial Blood Pressure is Associated with Carotid Wall Remodeling and Increased Arterial Stiffness in Childhood. High Blood Press Cardiovasc Prev 24, 49–60 (2017). https://doi.org/10.1007/s40292-017-0179-2

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