ESPN 53rd Annual Meeting

ESPN 2021


 
Aortic pulse wave velocity is primarily determined by blood pressure but not other cardiovascular risk factors during childhood: a call to arms to standardise results
KAROLIS AZUKAITIS 1 MANISH SINHA 2 AUGUSTINA JANKAUSKIENE 1 BOJKO BJELAKOVIC 3 MIECZYSłAW LITWIN 4 On behalf of HyperChildNET WG3 1

1- CLINIC OF PEDIATRICS, INSTITUTE OF CLINICAL MEDICINE, FACULTY OF MEDICINE, VILNIUS UNIVERSITY, VILNIUS, LITHUANIA
2- KINGS COLLEGE LONDON EVELINA LONDON CHILDRENS HOSPITAL, LONDON, UK
3- CLINIC OF PEDIATRICS, CLINICAL CENTER, NIS, SERBIA, MEDICAL FACULTY, UNIVERSITY OF NIS, NIS, SERBIA
4- DEPARTMENT OF NEPHROLOGY AND ARTERIAL HYPERTENSION, THE CHILDRENS MEMORIAL HEALTH INSTITUTE, WARSAW, POLAND
5- COST Action HyperChildNET
 
Introduction:

Pulse wave velocity (PWV) is the gold-standard for non-invasive assessment of arterial stiffening in patients with hypertension. Adult studies have shown that PWV is mainly determined by blood pressure (BP) and age. We aimed to systematically analyze determinants of PWV in studies involving children with primary hypertension (PH).

Material and methods:

196 articles retrieved from PubMed according to a predefined search strategy were screened for eligibility. 38 articles identified by title/abstract review underwent full-text screening by 2 reviewers and 12 were selected for the analysis if (i) measured carotid-femoral PWV (PWVcf); (ii) reported on risk associations using regression models; and (iii) included BMI and BP in the model.

Results:

The total population included >3700 children with normal and elevated BP. 25% studies used indirect methods for PWVcf estimation and 17% analyzed standardized PWVcf. Higher PWVcf in hypertensive vs non-hypertensive children was reported in 75% studies. 92% and 75% included age and sex, in regression models. In 83% studies PWV was positively associated with BP, whereas BMI associated with PWV in 25% only (positive 3 and negative association in 1). Age was positively associated in 18% and no studies reported any significant associations with sex. Association of race were reported in 2 studies only (direct effect of non-white race in 1). Models including BP among other covariates (biochemical, anthropometric and other BP parameters) explained 12-88% of PWVcf variability (R2 not reported in 25% of studies).

Conclusions:

BP is the predominate contributor to PWV, compared to the inconsistent or lesser contributions of BMI, age, sex or other CV risk factors during childhood. Additional studies are needed to determine whether increased PWV is a reflection of primary arterial disease or a secondary phenomenon. Our data also highlights the need of standardization and reporting of confounders, such as age and sex.