Insight into the 24-hour ambulatory central blood pressure in adolescents and young adults.

This study attempted to investigate the behavior of 24-hour central ambulatory blood pressure (ABP) in adolescents and young adults. Adolescents and young adults (age 10-25 years) referred for elevated blood pressure (BP) and healthy volunteers had simultaneous 24-hour peripheral (brachial) and central (aortic) ABP monitoring using the same automated upper-arm cuff device (Mobil-O-Graph 24h PWA). Central BP was calculated by the device using two different calibration methods (C1SBP using peripheral systolic (pSBP)/diastolic BP and C2SBP using mean arterial/diastolic BP). A total of 136 participants (age 17.9 ± 4.7 years, 54% adolescents, 77% males, 25% volunteers, 34% with elevated peripheral ABP) were analyzed. Twenty-four-hour pSBP was higher than C1SBP, with this difference being more pronounced during daytime than nighttime (16.3 ± 4.5 and 10.5 ± 3.2 mm Hg, respectively, P < .001). Younger age, higher body height, and male gender were associated with greater systolic ABP amplification (pSBP-C1SBP difference). C1SBP followed the variation pattern of pSBP, yet with smaller nighttime dip (8.4 ± 6.0% vs 11.9 ± 4.6%, P < .001), whereas C2SBP increased (2.4 ± 7.2%) during nighttime sleep (P < .001 for comparison with pSBP change). Older age remained independent determinant of larger nighttime BP fall for pSBP and C1SBP, whereas male gender predicted a larger nighttime C2SBP rise. These data suggest that the calibration method of the BP monitor considerably influences the diurnal variation in central BP, showing a lesser nocturnal dip than pSBP or even nocturnal BP rise, which are determined by the individual's age and gender.

Home and ambulatory blood pressure monitoring in children, adolescents and young adults: comparison, diagnostic agreement and association with preclinical organ damage.

OBJECTIVES: To compare the association of home (HBP), ambulatory (ABP) and office blood pressure (OBP) measurements with preclinical organ damage in young individuals. METHODS: Individuals referred for elevated blood pressure and healthy volunteers aged 6-25 years were evaluated with OBP (2-3 visits), 7-day HBP and 24-h ABP monitoring. Organ damage was assessed by echocardiographic left ventricular mass index (LVMI), carotid ultrasonography [intima--media thickness (IMT)] and pulse wave velocity (PWV) using piezo-electronic or oscillometric technique. RESULTS: Analysis included 251 individuals (mean age 14 ±â€Š3.9 years, 70.9% men: 31.1% children, 54.6% adolescents, 14.3% young adults) of whom 189 had LVMI, 123 IMT and 198 PWV measurements. Office, ambulatory and home hypertension was diagnosed in 29.5, 27.1 and 26.3% of participants. The agreement of OBP with ABP was 74.5% (kappa 0.37) and HBP 76.1% (kappa 0.41), with closer agreement between HBP and ABP (84.9%, kappa 0.61). LVMI gave comparable correlations with systolic OBP, 24-h ABP and HBP (r = 0.31/0.31/0.30, all P < 0.01). The same was the case for IMT (0.33/0.32/0.37, all P < 0.01) and piezo-electronic PWV (0.55/0.53/0.52, all P < 0.01), whereas oscillometric PWV gave stronger correlations with OBP than ABP or HBP. In linear regression analysis, the variation of LVMI was determined by night-time ABP, of IMT by HBP and of PWV by OBP and 24-h ABP. CONCLUSION: These data suggest that in young individuals, target organ damage is mainly determined by out-of-office rather than office BP. Home and ambulatory BP give comparable associations with preclinical organ damage.

Association of Central Versus Brachial Blood Pressure With Target-Organ Damage: Systematic Review and Meta-Analysis.

Accumulating evidence suggests that central blood pressure (BP) may reflect the hemodynamic stress on target organs more accurately than brachial BP. A systematic review assessing the relationship of central versus brachial BP with preclinical target-organ damage was performed. Meta-analysis of cross-sectional data showed that central compared with brachial systolic BP was more closely associated with (1) left ventricular mass index (12 studies, n=6431; weighted age [SD], 49.9 [13.1] years; 51% hypertensives): pooled correlation coefficients r=0.30; 95% confidence interval (CI), 0.23-0.37 versus r=0.26; 95% CI, 0.19-0.33, respectively; P<0.01 for difference; (2) carotid intima-media thickness (7 studies, n=6136; weighted age, 55.6 [13.2] years; 48% hypertensives): r=0.27; 95% CI, 0.19-0.34 versus r=0.23; 95% CI, 0.16-0.30, respectively; P<0.01 for difference; (3) pulse-wave velocity (14 studies, n=3699; weighted age, 53.9 [13.3] years; 53% hypertensives): r=0.42; 95% CI, 0.37-0.47 versus r=0.39; 95% CI, 0.33-0.45, respectively; P<0.01 for difference. Four studies assessing urine albumin excretion (n=3718; weighted age, 56.4 [5] years; 69% hypertensives) reported similar correlations (P=not significant) with central (r=0.22; 95% CI, 0.14-0.29) and brachial systolic BP (r=0.22; 95% CI, 0.12-0.32). Similar findings were observed for central compared with brachial pulse pressure in terms of relationship with target-organ damage. Metaregression analyses did not reveal any significant effect of age. In conclusion, central compared with brachial BP seems to be more strongly associated with most of the investigated indices of preclinical organ damage.