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24-Hour Central Ambulatory Blood Pressure is a Better Measurement in Young Patients


Presented by Angeliki Ntineri, Greece

Twenty-four–hour central ambulatory blood pressure (ceABP) is significantly lower than peripheral ABP (pABP) in adolescents and young adults, with higher BP associated with age, left ventricular mass index (LVMI), and common carotid intima-media thickness (cIMT). Angeliki Ntineri, MD, University of Athens, Athens, Greece, presented data from a study of 24-hour ceABP in adolescents and young adults.

BP amplification is highly variable and in young individuals, there is up to a 30 mmHg difference between ceABP and pABP. The hemodynamic load is more accurately measured by ceABP and is superior to pABP in predicting organ damage and outcomes. The 2013 European Society of Hypertension (ESH) and European Society of Cardiology (ESC) Guidelines for the management of arterial hypertension indicate that there is uncertainty regarding isolated systolic hypertension (ISH) in young individuals [Protogerou AD et al. J Hypertens 2013]. In addition, in young people, when pABP is high, it is likely a result of amplification as ceABP is frequently normal or low [O’Rourke MF, Adji A. J Hypertens 2013]. There are currently no data that demonstrate unfavorable outcomes in young patients with ISH, so there is no evidence to suggest that treatment is necessary. The purpose of this study was to delineate the relationship between 24-hour ceABP and pABP with preclinical target organ damage in young patients.

In this cross-sectional study, 44 apparently healthy individuals aged 12 to 25 years who were healthy volunteers or referred for elevated BP (but untreated) were assessed by somatometrics, BP, echocardiogram for LVMI, and cIMT. Measurements of ceABP and pABP were evaluated during routine work/school days at 20-minute intervals for 24 hours using a Mobil-O-Graph 24 hour pulse wave velocity (PWV) monitor.

At baseline, 22 participants were aged 12 to 18 years and 22 were aged 19 to 25 years. Of these 44 participants, 34% were healthy volunteers. The mean age of the study group was 18.8 years, 73% were male, and the mean body mass index was 24.1 kg/m2. ABP hypertension, defined as the 24-hour BP >95th percentile or >130/80 mmHg, was present in 18% of participants and high-normal ABP, defined as a 24-hour BP >90th percentile or >125/75 mmHg, was present in 21%.

The mean 24-hour ceABP was ~13 mm lower than the pABP (p<0.01). In addition, there was a close association between peripheral systolic ABP and central systolic ABP (r=0.94; p<0.01). Systolic BP amplification was significantly higher in males than in females, with a difference of 4.3 mmHg (p<0.01). However, there was no significant difference in SBP amplification among normotensives, high-normal, and hypertensives. Interestingly, increasing age was associated with a decrease in SBP amplification (r=-0.44; p<0.01). In addition, both 24-hour ceABP and pABP were significantly associated with LVMI (r=0.51 and r=0.43, respectively; p<0.01 for both) and common cIMT (r=0.42; p=0.005 and r=0.38; p=0.01, respectively). Similarly, there was a strong association between 24-hour PWV and ceABP and pABP (r=0.94 and r=0.92, respectively; p<0.01 for both).

Dr. Ntineri concluded that data from this study suggest that the difference in ceABP and pABP can be quite large; however, ceABP appears to be more closely associated with echocardiographic LVMI compared with pABP. Dr. Ntineri highlighted that further study is required to investigate the role of ceABP in young patients.



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