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Central blood pressure and pulse wave amplification across the spectrum of peripheral blood pressure in overweight and obese youth

Lurbe, Empar; Torro, María Isabel; Alvarez-Pitti, Julio; Redon, Pau; Redon, Josep

doi: 10.1097/HJH.0000000000000933
ORIGINAL PAPERS: Children
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Objective: To identify vascular phenotypes across blood pressure (BP) conditions in overweight and obese youths, by assessing office BP (oBP), and central BP (cBP), and pulse pressure (PP) amplification. Whether or not 24-h ambulatory BP monitoring (ABPM) and pulse wave velocity (PWV) add insight to the issue has also been examined.

Methods: White youths of both sexes with overweight or obesity and of European origin, ranging from 8 to 18 years of age, were included. oBP, cBP, PWV, and 24-h ABPM were measured. oBP conditions and ‘white-coat’ hypertension were defined as recommend by European Society Hypertension Guidelines in Children and Adolescents. Patients were divided into subgroups of ‘normal’ or ‘high’ according to cBP and PP ratio.

Results: A total of 593 patients (mean age, 12.2 ± 2.3 years; 275 women) were included in the study. The largest differences between office SBP and central SBP correspond to the isolated systolic hypertension (ISH) group, in which only 25% of patients have high cBP, in contrast to 50% of the systo-diastolic hypertension (SDH) group. Two patterns emerged based on cBP and PP ratio – while the highest cBP was among the SDH, the highest PP amplitude was in the ISH group. Ninety percent of the SDH were confirmed with 24-h ABPM, in contrast to 75% of the ISH, who were white-coat hypertensive. PWV showed a progressive increment across the groups from normotension to SDH. Significant differences were observed only when compared with the normotensive, but not among all other groups.

Conclusion: In overweight and obese hypertensive patients, ISH is prevalent, posing a challenge for the clinician of whether these may therefore be diagnosed and managed as hypertensive patients. Until prospective studies can give more knowledge, 24-h ABPM can offer information for making clinical decisions.

aDepartment of Pediatrics, Consorcio Hospital General, University of Valencia, Valencia

bCIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid

cINCLIVA Research Institute

dDepartment of Internal Medicine, Hypertension Clinic, Hospital Clinico de Valencia, University of Valencia, Valencia, Spain.

Correspondence to Empar Lurbe, MD, PhD, FAHA, Department of Pediatrics, Consorcio Hospital General, University of Valencia, Avda Tres Cruces s/n, 46014 Valencia, Spain. Tel: +34 96 3161800; e-mail: empar.lurbe@uv.es

Abbreviations: ABPM, ambulatory blood pressure monitoring; BP, blood pressure; cBP, central blood pressure; cDBP, central DBP; cPP, central pulse pressure; cSBP, central SBP, HR, heart rate; HTN, hypertension; ISH, isolated systolic hypertension; ISHN; high-normal peripheral SBP; NT, normotensive; oBP, office blood pressure; oDBP, office DBP; oPP, office pulse pressure; oSBP, office SBP; PP, pulse pressure; PWV, pulse wave velocity; SDH, systo-diastolic hypertensive

Received 4 January, 2016

Revised 7 March, 2016

Accepted 16 March, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.