Abstract 024: Arterial Stiffness Before Hypertension: A New Paradigm In Youth

Abstract

Arterial stiffness (AS) in adults is an independent predictor of cardiovascular mortality. Historically, AS and increased left ventricular mass index (LVMi) have been identified as consequences of hypertension. However, recent studies have shown that AS and LVMi can predict hypertension development in adults. AS and LVMi as determinants of pediatric BP have not been studied. We hypothesized that AS and LVMi are independent determinants of BP in youth. Baseline BP and AS data were collected on participants enrolled in a cohort study comparing the effects of type 2 diabetes and obesity on the cardiovascular system in youth to lean and obese controls. Follow up BP and AS were obtained 5-7 years after initial measurements. General linear models were used to determine if central AS (Pulse Wave Velocity, PWV) or wave reflections (Augmentation Index, Aix) or LVMi remained significant predictors of follow-up systolic or diastolic BP z-scores (SBPz, DBPz) after adjusting for covariates. A total of 425 participants were included in this study. The mean age at baseline was 17.6 years and at follow up 22.9 years. Baseline and change in PWV, LVMi and Aix predicted follow up SBPz and DBPz ( p= <0.001). After adjusting for age, sex, race, BMI, waist/height ratio, diabetes and BP, lipid and metabolic medications, both baseline and change in PWV remained independently associated with follow up SBPz and DBPz ( p= <0.001). LVMi remained independently associated with follow up SBPz ( p= <0.001), but not DBPz. Aix was no longer significant after adjusting for PWV and LVMi. In conclusion, central AS and LVMi predict future BP and may be useful in the identification of youth at risk for hypertension.