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Updated and revised normal values of aortic pulse wave velocity in children and adolescents aged 3–18 years

Journal of Human Hypertension volume 35, pages 604–612 (2021)Cite this article

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Abstract

Measurement of aortic pulse wave velocity (PWVao) is recommended for stratifying individual cardiovascular (CV) risk in adults. Diseases in children and adolescents might influence aortic stiffness. It is necessary to exclude overweight (OW), obese (O) subjects, and individuals with increased systolic (SBP) and/or diastolic blood pressure (DBP) from the population, when creating normal values of PWVao in children and adolescents. Body mass index (BMI), SBP/DBP cut-off values have remarkably changed in this population during the last decade. Aims of our study were to expand our previously published PWVao database and to revise it by using the recently determined normal values. PWVao was measured by an occlusive-oscillometric device (Arteriograph, TensioMed Ltd, Budapest, Hungary) in a healthy population aged 3–18 years. 7940 (4374 boys) participants were recruited, 1912 OW/O subjects and 1368 individuals with high SBP/DBP were excluded. Finally, n = 4690 (2599 boys) participants were enrolled. Mean PWVao values increased from 5.4 ± 0.6 to 6.4 ± 0.5 m/s (p < 0.05) in boys and from 5.5 ± 0.6 to 6.4 ± 0.5 m/s (p < 0.05) in girls. Mean PWVao values were significantly lower in our new study, in boys in age groups of 9–16, in girls in age groups of 11–17. This is the largest and widest age-ranged database of PWVao published to date. Due to the change of BMI and SBP/DBP reference values during the last decade, the “old” database of PWVao needed to be revised. As a result of this, normal values of PWVao decreased significantly in both sexes.

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Fig. 1
Fig. 2: Synopsis of smoothed percentile curves of PWVao for boys (A) and girls (B).
Fig. 3: Synopsis of published age-related median curves of PWVao and PWVcf for boys (A) and girls (B).

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References

  1. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55:1318–27.

    Article  Google Scholar 

  2. Tauzin L, Rossi P, Giusano B, Gaudart J, Boussuges A, Fraisse A, et al. Characteristics of arterial stiffness in very low birth weight premature infants. Pediatr Res. 2006;60:592–6.

    Article  Google Scholar 

  3. McEniery CM, Bolton CE, Fawke J, Hennessy E, Stocks J, Wilkinson IB, et al. Cardiovascular consequences of extreme prematurity: the EPICure study. J Hypertens. 2011;29:1367–73.

    Article  CAS  Google Scholar 

  4. Buehler T, Steinmann M, Singer F, Regamey N, Casaulta C, Schoeni MH, et al. Increased arterial stiffness in children with cystic fibrosis. Eur Respir J. 2012;39:1536–7.

    Article  Google Scholar 

  5. Turanlahti MI, Taskinen M, Saarinen-Pihkala U, Jokinen EV. Time-related arterial changes after allogeneic hematopoietic stem cell transplantation in children. Pediatr Res. 2013;73:777–82.

    Article  Google Scholar 

  6. Urbina EM, Khoury PR, McCoy CE, Dolan LM, Daniels SR, Kimball TR. Triglyceride to HDL-C ratio and increased arterial stiffness in children, adolescents, and young adults. Pediatrics. 2013;131:e1082–1090.

    Article  Google Scholar 

  7. Steinmann M, Abbas C, Singer F, Casaulta C, Regamey N, Haffner D, et al. Arterial stiffness is increased in asthmatic children. Eur J Pediatr. 2015;174:519–23.

    Article  Google Scholar 

  8. Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  Google Scholar 

  9. Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, et al. European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34:1887–920.

    Article  CAS  Google Scholar 

  10. Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation. 2003;107:2864–9.

    Article  Google Scholar 

  11. Urbina EM, Williams RV, Alpert BS, Collins RT, Daniels SR, Laura Hayman L, et al. Noninvasive assessment of subclinical atherosclerosis in children and adolescents. Hypertension. 2009;54:919–50.

    Article  CAS  Google Scholar 

  12. O’Rourke MF. Arterial hemodynamics in hypertension. Circulation Res. 1970;26-27(Suppl.II):123–33.

    Google Scholar 

  13. McEniery CM, Yasmin X, Wallace S, McDonell B, Sharman JE, Retallik C, et al. Increased stroke volume and aortic stiffness contributes to isolated systolic hypertension in young adults. Hypertension. 2005;46:221–6.

    Article  CAS  Google Scholar 

  14. Schütten MTJ, Houben AJHM, de Leeuw PW, Stehouwer CDA. The link between adipose tissue renin-angiotensin-aldosterone system signaling and obesity-associated hypertension. Physiology. 2017;32:197–209.

    Article  Google Scholar 

  15. Cole TJ, Lobstein T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes. 2012;7:284–94.

    Article  CAS  Google Scholar 

  16. Schwandt P, Scholze JE, Bertsch T, Liepold E, Hass GM. Blood pressure percentiles in 22,051 German children and adolescents: the PEP family heart study. Am J Hypertens. 2015;28:672–9.

    Article  Google Scholar 

  17. Flynn JT, Kaelber DC, Baker-Smith CM. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(Sept):e20171904.

    Article  Google Scholar 

  18. Hidvégi EV, Illyés M, Benczúr B, Böcskei RM, Rátgéber L, Lenkey Z, et al. Reference values of aortic pulse wave velocity in a large healthy population aged between 3 and 18 years. J Hypertens. 2012;30:2314–21.

    Article  Google Scholar 

  19. WHO. Physical status: the use and interpretation of anthropometry. Geneva, Switzerland: Report of WHO expert committee; 1995.

    Google Scholar 

  20. Horváth IG, Németh A, Lenkey Z, Alessandri N, Tufano F, Kis P, et al. Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity. J Hypertens. 2010;28:2068–75.

    Article  Google Scholar 

  21. Baulmann J, Schillings U, Rickert S, Uen S, Düsing R, Illyés M, et al. A new oscillometric method for assessment of arterial stiffness: comparison with tonometric and piezo-electronic methods. J Hypertens. 2008;26:523–8.

    Article  CAS  Google Scholar 

  22. Cole TJ, Green PJ. Smoothing reference centile curves: the LMS method and penalised likelihood. Statitics Med. 1992;11:1305–19.

    Article  CAS  Google Scholar 

  23. Pan H, Cole TJ. LMS Chartmaker, a programme to construct growth references using the LMS 2010. Version 2.43. http://www.healthforallchildren.co.uk/.

  24. Rosario AS, Kurth BM, Stolzenberg H, Ellert U, Neuhauser H. Body mass index percentiles for children and adolescents in Germany based on a nationally representative sample (KiGGS 2003-2006). Eur J Clin Nutr. 2010;64:341–9.

    Article  Google Scholar 

  25. Falkner B, Daniels SR, Flynn JT, Gidding S, Green LA, Ingelfinger JR, et al. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–76.

    Article  Google Scholar 

  26. Lu X, Shi P, Luo CY, Zhou YF, Yu HT, Guo CY, et al. Prevalence of hypertension in overweight and obese children from a large school-based population in Shanghai, China. BMC Public Health. 2013;13:1–7.

    Article  CAS  Google Scholar 

  27. Lo JC, Chandra M, Sinaiko A, Daniels SR, Prineas RJ, Maring B, et al. Severe obesity in children: prevalence, persistence and relation to hypertension. Int J Pediatr Endocrinol. 2014;3:1–8.

    Google Scholar 

  28. Reusz GS, Cseprekal O, Temmar M, Kis É, Cherif AB, Thaleb A, et al. Reference values of pulse wave velocity in healthy children and teenagers. Hypertension. 2010;56:217–24.

    Article  CAS  Google Scholar 

  29. Elmenhorst J, Hulpke-Wette M, Barta C, Dalla Pozza R, Springer S, Oberhoffer R. Percentiles for central blood pressure and pulse wave velocity in children and adolescents recorded with an oscillometric device. Atherosclerosis. 2015;238:9–16.

    Article  CAS  Google Scholar 

  30. Thurn D, Doyon A, Sözeri B, Bayazit AK, Canpolat N, Duzova A, et al. Aortic pulse wave velocity in Healthy children and adolescents: reference values for the Vicorder device and modifying factors. Am J Hypertens. 2015;28:1480–8.

    Article  CAS  Google Scholar 

  31. Díaz A, Zócalo Y, Bia D, Sabino F, Rodriguez V, Cabrera-Fisher E. Reference intervals of aortic pulse wave velocity assessed with an oscillometric device in healthy children and adolescents from Argentina. Clin Exp Hypertens. 2019;41:101–12.

    Article  Google Scholar 

  32. Salvi P, Furlanis G, Grillo A, Pini A, Salvi L, Marelli S, et al. Unreliable estimation of aortic pulse wave velocity provided by the Mobil-O-Graph algorithm-based system in Marfan syndrome. J Am Heart Assoc. 2019;8:e011440. https://doi.org/10.1161/JAHA.118.01440.

    Article  Google Scholar 

  33. Salvi P, Scalise F, Rovina M, Moretti F, Salvi L, Grillo A, et al. Noninvasive estimation of aortic stiffness through different approaches comparison with intra-aortic recordings. Hypertension. 2019;74:00–00. https://doi.org/10.1161/HYPERTENSIONAHA.119.12853.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Heart Institute, Faculty of Medicine, University of Pécs, Pécs, Hungary

    Erzsébet Valéria Hidvégi, Zsófia Lenkey, Attila Cziráki & Miklós Illyés

  2. Department of Pediatrics, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary

    Andrea Emese Jakab & Csaba Bereczki

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  1. Erzsébet Valéria Hidvégi
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Hidvégi, E.V., Jakab, A.E., Lenkey, Z. et al. Updated and revised normal values of aortic pulse wave velocity in children and adolescents aged 3–18 years. J Hum Hypertens 35, 604–612 (2021). https://doi.org/10.1038/s41371-020-0374-9

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