Title:Increases in Peripheral Systolic Pressure Levels and Z-score Associate Gradual Aortic Pressure Increase and Functional Arterial Impairment in Children and Adolescents
VOLUME: 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
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 , 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
Keywords:Arterial wall, arterial hypertension, blood pressure, central aortic blood pressure, children.
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.
