Childhood Determinants of Arterial Dysfunction Central and Peripheral Blood Pressure

Abstract

Arterial Hypertension is one of the leading causes of death and disability worldwide. Measurement of peripheral brachial blood pressure using cuff sphygmomanometry belongs to the clinical routine assessment from childhood on. Based on age and length related reference values, it is widely accepted as surrogate marker of later cardiovascular events. Peripheral arterial pressure, however, does not necessarily reflect central aortic pressure, which seems to predict cardiovascular (CV) risk even better: many vital organs like brain and kidneys are perfused with aortic pressure, and keeping the systolic pressure amplification within the arterial tree in mind, the difference between peripheral and central blood pressure shows a wide variety.

Nowadays, oscillometric devices are able to measure central aortic as easy as peripheral blood pressure, but the clinical acceptance of the method is still low. Reference values for central arterial pressure in youth are existing and could help in CV risk stratification: we defined central systolic pressure ranges from 90 ± 5.8 mm Hg to 110.5 ± 9.6 mm Hg in boys and from 91.2 ± 7.5 mm Hg to 109.1 ± 8.6 mmHg in a cohort of 1445 children and young adults. Other central blood pressure measures, however, may show different results, and factors influencing the pressure amplification and end organ damage in childhood have to be defined in large series.