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Central blood pressure in children and adolescents: non-invasive development and testing of novel transfer functions

Journal of Human Hypertension volume 31, pages 831–837 (2017)Cite this article

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Abstract

Central blood pressure can be estimated from peripheral pulses in adults using generalised transfer functions (TF). We sought to create and test age-specific non-invasively developed TFs in children, with comparison to a pre-existing adult TF. We studied healthy children from two sites at two time points, 8 and 14 years of age, split by site into development and validation groups. Radial and carotid pressure waveforms were obtained by applanation tonometry. Central systolic pressure was derived from carotid waveforms calibrated to brachial mean and diastolic pressures. Age-specific TFs created in the development groups (n=50) were tested in the validation groups aged 8 (n=137) and 14 years (n=85). At 8 years of age, the age-specific TF estimated 82, 99 and 100% of central systolic pressure values within 5, 10 and 15 mm Hg of their measured values, respectively. This TF overestimated central systolic pressure by 2.2 (s.d. 3.7) mm Hg, compared to being underestimated by 5.6 (s.d. 3.9) mm Hg with the adult TF. At 14 years of age, the age-specific TF estimated 60, 87 and 95% of values within 5, 10 and 15 mm Hg of their measured values, respectively. This TF underestimated central systolic pressure by 0.5 (s.d. 6.7) mm Hg, while the adult TF underestimated it by 6.8 (s.d. 6.0) mm Hg. In conclusion, age-specific TFs more accurately predict central systolic pressure measured at the carotid artery in children than an existing adult TF.

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References

  1. Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386 (9995): 743–800.

    Article  Google Scholar 

  2. McNiece KL, Gupta-Malhotra M, Samuels J, Bell C, Garcia K, Poffenbarger T et al. Left ventricular hypertrophy in hypertensive adolescents: analysis of Risk by 2004 National High Blood Pressure Education Program Working Group Staging Criteria. Hypertension 2007; 50 (2): 392–395.

    Article  CAS  Google Scholar 

  3. Chen X, Wang Y . Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 2008; 117 (25): 3171–3180.

    Article  Google Scholar 

  4. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114 (2): 555–576.

    Article  Google Scholar 

  5. Chen C-H, Nevo E, Fetics B, Pak PH, Yin FCP, Maughan WL et al. Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure: validation of generalized transfer function. Circulation 1997; 95 (7): 1827–1836.

    Article  CAS  Google Scholar 

  6. Chen C-H, Ting C-T, Nussbacher A, Nevo E, Kass DA, Pak P et al. Validation of carotid artery tonometry as a means of estimating augmentation index of ascending aortic pressure. Hypertension 1996; 27 (2): 168–175.

    Article  CAS  Google Scholar 

  7. Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM, Ali T et al. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: The Strong Heart Study. Hypertension 2007; 50 (1): 197–203.

    Article  CAS  Google Scholar 

  8. Roman MJ, Devereux RB, Kizer JR, Okin PM, Lee ET, Wang W et al. High central pulse pressure is independently associated with adverse cardiovascular outcome. The Strong Heart Study. J Am Coll Cardiol 2009; 54 (18): 1730–1734.

    Article  Google Scholar 

  9. Boutouyrie P, Achouba A, Trunet P, Laurent S, Grp ET, Group ET et al. Amlodipine-valsartan combination decreases central systolic blood pressure more effectively than the amlodipine-atenolol combination: The EXPLOR Study. Hypertension 2010; 55 (6): 1314–1322.

    Article  CAS  Google Scholar 

  10. Heffernan KS, Fahs CA, Iwamoto GA, Jae SY, Wilund KR, Woods JA et al. Resistance exercise training reduces central blood pressure and improves microvascular function in African American and white men. Atherosclerosis 2009; 207 (1): 220–226.

    Article  CAS  Google Scholar 

  11. Agabiti-Rosei E, Mancia G, O’Rourke MF, Roman MJ, Safar ME, Smulyan H et al. Central blood pressure measurements and antihypertensive therapy: a consensus document. Hypertension 2007; 50 (1): 154–160.

    Article  CAS  Google Scholar 

  12. Mihrshahi S, Peat JK, Webb K, Tovey ER, Marks GB, Mellis CM et al. The childhood asthma prevention study (CAPS): design and research protocol of a randomized trial for the primary prevention of asthma. Control Clin Trials 2001; 22 (3): 333–354.

    Article  CAS  Google Scholar 

  13. Ayer JG, Harmer JA, Xuan W, Toelle B, Webb K, Almqvist C et al. Dietary supplementation with n−3 polyunsaturated fatty acids in early childhood: effects on blood pressure and arterial structure and function at age 8 y. Am J Clin Nutr 2009; 90 (2): 438–446.

    Article  CAS  Google Scholar 

  14. Jones CR, Taylor K, Poston L, Shennan AH . Validation of the Welch Allyn ‘Vital Signs’ oscillometric blood pressure monitor. J Hum Hypertens 2001; 15 (3): 191–195.

    Article  CAS  Google Scholar 

  15. Pauca AL, O'Rourke MF, Kon ND . Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 2001; 38 (4): 932–937.

    Article  CAS  Google Scholar 

  16. White WB, Berson AS, Robbins C, Jamieson MJ, Prisant LM, Roccella E et al. National Standard for Measurement of Resting and Ambulatory Blood Pressures With Automated Sphygmomanometers. Hypertension 1993; 21 (4): 504–509.

    Article  CAS  Google Scholar 

  17. O'Brien E, Atkins N, Stergiou G, Karpettas N, Parati G, Asmar R et al. European Society of Hypertension International Protocol revision 2010 for the validation of blood pressure measuring devices in adults. Blood Press Monit 2010; 15 (1):23–38.

    Article  Google Scholar 

  18. Pauca AL, Wallenhaupt SL, Kon ND, Tucker WY . Does radial artery pressure accurately reflect aortic pressure? Chest 1992; 102 (4): 1193–1198.

    Article  CAS  Google Scholar 

  19. Cheng H-M, Lang D, Tufanaru C, Pearson A . Measurement accuracy of non-invasively obtained central blood pressure by applanation tonometry: a systematic review and meta-analysis. Int J Cardiol 2013; 167 (5): 1867–1876.

    Article  Google Scholar 

  20. Milne L, Keehn L, Guilcher A, Reidy JF, Karunanithy N, Rosenthal E et al. Central aortic blood pressure from ultrasound wall-tracking of the carotid artery in children: comparison with invasive measurements and radial tonometry. Hypertension 2015; 65 (5): 1141–1146.

    Article  CAS  Google Scholar 

  21. Nichols WW, Singh BM . Augmentation index as a measure of peripheral vascular disease state. Curr Opin Cardiol 2002; 17 (5): 543–551.

    Article  Google Scholar 

  22. Nürnberger J, Keflioglu-Scheiber A, Opazo Saez AM, Wenzel RR, Philipp T, Schäfers RF . Augmentation index is associated with cardiovascular risk. J Hypertens 2002; 20 (12): 2407–2414.

    Article  Google Scholar 

  23. Vlachopoulos C, Aznaouridis K, O'Rourke MF, Safar ME, Baou K, Stefanadis C . Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J 2010; 31 (15): 1865–1871.

    Article  Google Scholar 

  24. Wilkinson IB, Fuchs SA, Jansen IM, Spratt JC, Murray GD, Cockcroft JR et al. Reproducibility of pulse wave velocity and augmentation index measured by pulse wave analysis. J Hypertens 1998; 16 (12): 2079–2084.

    Article  CAS  Google Scholar 

  25. Fetics B, Nevo E, Chen C-H, Kass DA . Parametric model derivation of transfer function for noninvasive estimation of aortic pressure by radial tonometry. IEEE Trans Biomed Eng 1999; 46 (6): 698–706.

    Article  CAS  Google Scholar 

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Acknowledgements

This work was supported by a NSW CVRN Research Development Project Grant (#101135) from the National Heart Foundation of Australia; Cooperative Research Centre for Asthma, Department of Health, Children’s Hospital at Westmead, and National Health and Medical Research Council of Australia Project and Program Grants (#222722; #482800); and The Financial Markets Foundation for Children grant (#2012-114). MRS is supported by a Future Leader fellowship from the National Heart Foundation of Australia (#100419).

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Authors and Affiliations

  1. Sydney Medical School, University of Sydney, Sydney, NSW, Australia

    T Y Cai, J G Ayer, S O'Meagher, D S Celermajer & M R Skilton

  2. Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, NSW, Australia

    T Y Cai, C Melki & M R Skilton

  3. Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia

    T Y Cai, C Melki & M R Skilton

  4. Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia

    A Qasem, M Butlin & A Avolio

  5. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    J G Ayer, S O'Meagher & D S Celermajer

  6. School of Public Health, University of Sydney, Sydney, NSW, Australia

    G B Marks

  7. Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia

    G B Marks

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  1. T Y Cai
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Correspondence to M R Skilton.

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AQ is an employee of AtCor Medical. The remaining authors declare no conflict of interest.

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Cai, T., Qasem, A., Ayer, J. et al. Central blood pressure in children and adolescents: non-invasive development and testing of novel transfer functions. J Hum Hypertens 31, 831–837 (2017). https://doi.org/10.1038/jhh.2017.59

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