Author + information
- Diana L.S. Ferreira, MSc, PhD,
- Abigail Fraser, MA, MPH, PhD,
- Laura D. Howe, MSc, PhD,
- Siana Jones, MSc,
- George Davey Smith, MA, MD, BChir, MSc,
- Debbie A. Lawlor, MBChB, MSc, PhD,
- Robyn J. Tapp, Dip, BA, GradDip, PhD,
- Andy R. Ness, BM, BS, PhD,
- John E. Deanfield, BA, BChir, MB,
- Nish Chaturvedi, MBBS, MSc, MD and
- Alun D. Hughes, MBBS, PhD∗ ()
- ↵∗Institute of Cardiovascular Sciences, University College London, London, WC1E 6BT, United Kingdom
Most studies relating blood pressure (BP) to target organ damage measure BP at the brachial artery, but pulse pressure (PP) and systolic BP (SBP) in the aorta are lower than the corresponding peripheral measures. In adults, aortic (central) PP and SBP have been shown to be more closely related to target organ damage and cardiovascular events (1) than peripheral pressures. We compared central and peripheral PP and their associations with concurrent measures of cardiac structure and function in a large, population-based cohort of adolescents.
The ALSPAC (Avon Longitudinal Study of Parents and Children) study, a prospective population-based birth cohort study, evaluated 1,695 participants (45% male; mean age 17.7 years) who underwent echocardiography examinations. Exclusion criteria included pregnancy and congenital heart disease. The ALSPAC Law and Ethics Committee and the Local Research Ethics Committee provided ethical approved. Participants provided written informed consent. Sitting peripheral BP was measured using an Omron 705-IT, and central BP was assessed by radial artery tonometry (Sphygmocor, AtCor Medical, West Ryde, Australia). Echocardiography was performed using ultrasound (HDI 5000, Philips Healthcare, North Andover, Massachusetts) equipped with a P4-2 Phased Array ultrasound transducer according to American Society of Echocardiography guidelines (2). Multivariable linear regression was used to assess associations. Data for sexes were pooled and models adjusted for age, sex, and dual-energy x-ray absorptiometry-assessed fat mass. Bootstrapping (10,000 replications) was used to compare associations of central and peripheral PP.
Peripheral PP was higher than central (mean difference ± SD: 19.7 ± 4.9 mm Hg), and the difference increased with increasing values of PP. Central and peripheral PP were positively associated with left ventricular (LV) mass indexed to height 2.7, LV internal diameter, left atrial size, mitral E/A ratio (the ratio of the peak early to the peak atrial mitral inflow velocities), and peak myocardial wall velocities in early diastole (e′). They also were inversely associated with peak myocardial wall velocities in systole (s′) (Table 1). Associations were significantly stronger for central compared with peripheral PP. Associations were slightly attenuated after adjustment for fat mass (model 2) but remained stronger for central PP. Neither central nor peripheral PP were associated with relative wall thickness, ejection fraction, or E/e′ (the ratio of the peak early mitral inflow velocity to the peak early myocardial velocity in diastole) (data not shown).
Wave reflections account for higher peripheral than central PP (PP amplification) (3). We show that PP amplification is particularly marked in young people, and varies considerably between individuals. Consequently, previous studies using peripheral BP may underestimate the strength of associations between BP and cardiac measures in youth. This may have important implications for diagnosis, prognosis, and therapeutic management of elevated BP in pediatric populations. In adults, high central PP is associated with diastolic dysfunction (4). In adolescents, we demonstrate that higher PP (particularly central PP) is associated with increased LV mass and left atrial size. The latter suggests some early unfavorable impact on diastolic function. Positive associations between higher PP and lower early s′ also suggest an early adverse influence of high central PP on systolic function and ventricular-arterial coupling (5), even at this young age. In view of the current epidemic of obesity in youth, this may have important implications for future cardiovascular risk.
Please note: All authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Ferreira and Fraser contributed equally to this work.
- American College of Cardiology Foundation
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