Research Article
Arterial stiffness is increased in young normotensive subjects with high central blood pressure

https://doi.org/10.1016/j.jash.2015.01.013Get rights and content

Highlights

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    We describe for the first time a new blood pressure (BP) pattern in young subjects.

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    This pattern is characterized by normal peripheral and high central BP values.

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    This BP pattern is associated with a worse CV risk profile and higher risk of TOD.

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    Some easy clinical predictors can help clinicians to identify this BP pattern.

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    Other studies may be useful to demonstrate the prognostic impact in adult age.

Abstract

Information on high central blood pressure (CBP; HCP) in normotensive subjects (NT) and its relation to target organ damage (TOD) is not well established in young subjects. This study aimed to elucidate determinants of HCP and its relation with TOD. Anthropometrics, lab, brachial, and CBP were obtained on 430 normotensive subjects (NT; 16–24 years, 34% male, 44% Caucasian, 27% type 2 diabetes). HCP was defined as elevated CBP, with normal brachial BP. Subjects with HCP (prevalence, 16%) were more frequently female and African American, and had a higher prevalence of obesity and diabetes, a more adverse metabolic profile, higher levels of inflammation, brachial BP, central pulse pressure, and heart rate compared with NT. HCP also had evidence for TOD with a significant higher carotid intima media thickness, left ventricular mass, augmentation index, pulse wave velocity, and lower brachial distensibility than NT. HCP is related to early cardiac and vascular dysfunction and remain an independent predictor of TOD even after adjusting for cardiovascular risk factors.

Introduction

Hypertension is a major risk factor for cardiovascular (CV) disease.1 However, CV disease is not entirely explained by classic risk factors, and a growing body of evidence suggests that parameters of central hemodynamics predict the occurrence of CV events independently of peripheral blood pressure (BP) values.2, 3, 4 Furthermore, central BP may be a stronger determinant of left ventricular hypertrophy,5, 6 vascular hypertrophy,2, 5 and glomerular filtration rate5 than brachial BP values.

The relationship between central and peripheral BP may also be important in determining CV risk. In young normotensive patients, the phenomenon of pulse pressure (PP) amplification results in higher peripheral systolic BP (SBP) than central SBP values, while the diastolic and mean pressures change little across the arterial tree.7 However, even in ‘normotensive’ adults, there may be only a slight difference between central and peripheral SBP,8 and this reduction in PP amplification is associated with an increased prevalence of CV disease and is a significant predictor of CV mortality.9, 10, 11 Therefore, the assessment of both central and peripheral BP would be important in the correct management of high BP.

To the best of our knowledge, a BP pattern characterized by normal systo–diastolic peripheral BP values with high central SBP has not been described (high central BP; HCP). Therefore, the aim of the present study was to describe this new BP pattern, to evaluate its determinants, and to explore if it confers increased risk for target organ damage in a cohort of young subjects.

Section snippets

Study Population

A total of 493 youth were examined as part of an ongoing study of the effects of obesity and type 2 diabetes mellitus (T2DM) on cardiac and vascular structure and function in adolescents and young adults (16–24 years; 61% non–Caucasian; 34% male). All subjects with T2DM were recruited and matched by age, gender, and race to both a lean and an obese, non–diabetic control. Patients who were pregnant or had a diagnosis of hypertension (HTN; Fourth Report on BP in children12 and Seventh Report of

Results

The study population (N = 474; mean age, 19.6 years; range, 16–24 years) were 66% female and 60% non–Caucasian (mostly African American) since the cohort recruited subjects with T2DM and there is a higher prevalence of T2DM in African American females in Cincinnati. Only 4% of the subjects admitted to smoking (Table 1). Eighty–four percent (N = 397) had normal central BP, while 16% (N = 77) had HCP. Subjects with HCP were more likely to be female and African American.

Compared with NT, those

Discussion

Our data describe, for the first time, a new BP pattern characterized by normal brachial BP in combination with high central BP. This is of importance since it is not rare in our young population, comprising 16% of our cohort. Furthermore, this BP pattern appears to be associated with more adverse CV risk profile and is similar to masked ambulatory HTN,28 with greater target organ damage. It is also interesting to note that the incremental risk of HCP on TOD may be more pronounced in subjects

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    This study received support from the National Institutes of Health (grant NIH R01 HL 076269).

    Dr Urbina has received a small grant from AtCor Medical, Inc. No other authors have relationships to disclose.

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    Copyright © 2015 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.