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Brachial-cuff excess pressure is associated with carotid intima-media thickness among Australian children: a cross-sectional population study


Reservoir pressure parameters (i.e., reservoir pressure [RP] and excess pressure [XSP]) independently predict cardiovascular events in adults, but this has not been investigated in children. This study aimed to determine (1) the association of reservoir pressure parameters with carotid intima-media thickness (carotid IMT), a preclinical vascular phenotype, and (2) whether a multivariable regression model with or without reservoir pressure parameters fits better for estimating carotid IMT in children. Study participants were 11–12-year-old children (n = 1231, 50% male) from the Child Health CheckPoint study, a cross-sectional substudy of the population-based Longitudinal Study of Australian Children. RP and XSP were obtained using brachial-cuff oscillometry (SphygmoCor XCEL, AtCor, Sydney). Carotid IMT was quantified by vascular ultrasonography. XSP was associated with carotid IMT after adjusting for confounders including age, sex, BMI z-score, heart rate, pubertal stage, moderate-to-vigorous physical activity, and mean arterial pressure (β = 0.93 µm, 95% CI 0.30–1.56 for XSP peak and β = 0.04 µm, 95% CI 0.01–0.08 for XSP integral). The results of the likelihood ratio test indicated a trend that the model with XSP and the above confounders fit better than a similar model without XSP for estimating carotid IMT. Our findings indicate that brachial-cuff device-measured XSP is associated with carotid IMT independent of conventional cardiovascular risk factors, including standard BP. This implies that a clinically convenient cuff approach could provide meaningful information for the early assessment of cardiovascular risk among children.

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To date, this work has been supported by the National Health and Medical Research Council of Australia (1041352, 1109355), the Royal Children’s Hospital Foundation (2014-241), the Murdoch Children’s Research Institute, the University of Melbourne, the National Heart Foundation of Australia (100660), and the Financial Markets Foundation for Children (2014-055). The funding bodies played did not play any role in the study. The following authors were supported by the National Health and Medical Research Council of Australia: Early Career Fellowship (1104731) to MGS, R.D. Wright Career Development Fellowship (1143510) to JM, Senior Research Fellowships (1046518) to MW and (1064629, 1175744) to DPB, and Career Development Fellowship (reference 409940) to JS. MW was also supported by Cure Kids, New Zealand, and DB and JM were also supported by the Future Leader Fellowship of the National Heart Foundation of Australia (100369 and 101866). MJ was supported by the Federal Research Grant of Finland to Turku University Hospital, Finnish Cardiovascular Foundation. This article uses unit record data from the LSAC. The study is conducted in partnership between the Department of Social Services (DSS), the Australian Institute of Family Studies (AIFS), and the Australian Bureau of Statistics (ABS). The findings and views reported in this article are those of the author and should not be attributed to DSS, AIFS, or the ABS. We are also grateful to Mr. Xun Yang, HeFei University of Technology, China for providing some technical assistance.

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XP contributed to data collection, analysis, and interpretation of data and drafting of paper; DSP, MGS, and JES: project conception and study design, interpretation of data, and critical revision of paper; MW: Health Design Leader LSAC, principal investigator Child Health CheckPoint, project conception and critical revision of paper; MC, DPB, and MJ: project conception and critical revision of paper; GC and SE: statistical assistance and critical revision of paper; JM: suggestion of data analysis and critical revision of paper.

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Correspondence to James E. Sharman.

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Peng, X., Picone, D.S., Schultz, M.G. et al. Brachial-cuff excess pressure is associated with carotid intima-media thickness among Australian children: a cross-sectional population study. Hypertens Res 44, 541–549 (2021).

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  • Waveform analysis
  • Blood pressure monitor
  • Atherosclerosis
  • Childhood


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