• Hypertensive Disease
• Cardiology Clinical Trials

• Hypertensive Disease
• Cardiology Clinical Trials
• Cardiology

Twenty-four-hour central ambulatory blood pressure (ceABP) was shown to be significantly lower than peripheral ambulatory blood pressure (pABP) in adolescents and young adults. Higher blood pressure (BP) was found to be correlated with left ventricular mass index (LVMI) and common carotid intima-media thickness (cIMT). Angeliki Ntineri, MD, University of Athens, Athens, Greece, presented data from a study of 24-hour ceABP in adolescents and young adults.

pABP is known to be higher than ceABP in young patients (up to 30 mm Hg) because of amplification of the ejection wave by reflected waves in the peripheral arterial tree. The central hemodynamic load is thus more accurately measured by ceABP and is superior to pABP in predicting organ damage and outcomes. The 2013 European Society of Hypertension and European Society of Cardiology guidelines for the management of arterial hypertension indicate uncertainty regarding the significance of isolated systolic hypertension in young persons when measured peripherally [Protogerou AD et al. J Hypertens 2013], especially since ceABP is frequently normal or low in the same patients [O'Rourke MF, Adji A. J Hypertens 2013]. No current data show unfavorable outcomes in young patients with isolated systolic hypertension, so there is no evidence to suggest that treatment is necessary. The purpose of this study was to describe the potential relationships between 24-hour ceABP and pABP with preclinical target organ damage in young patients.

In this cross-sectional study, 44 apparently healthy people aged 12 to 25 years who were healthy volunteers or referred for elevated BP (but untreated) were assessed by somatometrics, BP, echocardiogram for LVMI, and cIMT. Measurements of ceABP and pABP were evaluated during routine work or school days at 20-minute intervals for 24 hours via a Mobil-O-Graph 24-hour pulse wave velocity (PWV) monitor.

At baseline, half the participants were less than 19 years of age. The mean age of the study group was 18.8 years; 73% were male; and the mean body mass index was 24.1 kg/m². High ambulatory BP—defined as the 24-hour BP >95th percentile or >130/80 mm Hg—was present in 18% of participants. High-normal ambulatory BP—defined as a 24-hour BP >90th percentile or >125/75 mm Hg—was present in 21%.

Mean 24-hour ceABP was ∼13 mm Hg lower than pABP (p<0.01). In addition, there was a high correlation between systolic pABP and systolic ceABP (r=0.94; p<0.01). Systolic BP amplification was higher in males than in females, with a difference of 4.3 mm Hg (p<0.01). There was no difference in systolic BP (SBP) amplification among normotensives, high-normal, and hypertensives. Increasing age was associated with a decrease in SBP amplification (r=–0.44; p<0.01). Both 24-hour ceABP (r=0.51; p<0.01) and pABP (r=0.43; p<0.01) were associated with LVMI; 24-hour ceABP (r=0.42; p=0.005) and pABP (r=0.38; p=0.01) were also associated with common cIMT. Similarly, there was a strong correlation between 24-hour PWV and ceABP and pABP (r=0.94 and r=0.92, respectively; p<0.01 for both).

Dr. Ntineri concluded that data from this study confirmed that the difference in ceABP and pABP can be quite large. Prospective studies are needed to investigate the role of ceABP in young patients.

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