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Increases in Peripheral Systolic Pressure Levels and Z-score Associate Gradual Aortic Pressure Increase and Functional Arterial Impairment in Children and Adolescents

[ Vol. 14 , Issue. 2 ]

Author(s):

Yanina Zocalo*, Mariana Marin, Santiago Curcio, Victoria Garcia-Espinosa, Pedro Chiesa, Gustavo Giachetto, Edmundo I. Cabrera-Fischer and Daniel Bia   Pages 170 - 182 ( 13 )

Abstract:


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.

Keywords:

Arterial wall, arterial hypertension, blood pressure, central aortic blood pressure, children.

Affiliation:

Physiology Department, Faculty of Medicine, Centro Universitario de Investigacion, Innovacion y Diagnóstico Arterial (CUiiDARTE), Republic University, Montevideo, Physiology Department, Faculty of Medicine, Centro Universitario de Investigacion, Innovacion y Diagnóstico Arterial (CUiiDARTE), Republic University, Montevideo, Physiology Department, Faculty of Medicine, Centro Universitario de Investigacion, Innovacion y Diagnóstico Arterial (CUiiDARTE), Republic University, Montevideo, Physiology Department, Faculty of Medicine, Centro Universitario de Investigacion, Innovacion y Diagnóstico Arterial (CUiiDARTE), Republic University, Montevideo, Servicio de Cardiologia Pediatrica, Centro Hospitalario Pereira Rossell, ASSE-Ministry of Public Health, Montevideo, Clínica Pediátrica "C", Centro Hospitalario Pereira Rossell, ASSE - Republic University, Montevideo, Instituto de Medicina Traslacional, Trasplante y Bioingenieria- IMTTyB, Favaloro University, CONICET, Buenos Aires, Physiology Department, Faculty of Medicine, Centro Universitario de Investigacion, Innovacion y Diagnóstico Arterial (CUiiDARTE), Republic University, Montevideo

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