CAROTID VERSUS BRACHIAL BLOOD PRESSURE IN CHILDREN AND ADOLESCENTS

Abstract

Objective: To compare carotid and brachial office blood pressure (BP) in terms of their association with 24-hour ambulatory BP and preclinical organ damage in children and adolescents. Design and method: Apparently healthy children and adolescents (age 6–18 yeas) referred for elevated BP were subjected to (i) measurements of office brachial BP measurement (Microlife WatchBP Home N; duplicate measurements), carotid BP and carotid-femoral pulse wave velocity (Complior Analyse device; duplicate measurements), (ii) 24-hour ABP monitoring (Microlife WatchBP O3), (iii) carotid intima-media thickness (cIMT) measurement (high resolution B-mode ultrasonography) at the level of common carotid and bulb bilaterally using automated software, and (iv) echocardiographic determination of left ventricular mass index (LVMI). Results: 64 individuals were included (mean age 12.9 ± 3.2 years, 37 males, BMI 24.5 ± 5.1 kg/m2, 11 with ambulatory hypertension [BP >=95th percentile or >=130/80 mmHg]). Carotid office systolic BP (SBP) was lower than brachial office SBP (120.1 ± 16.7 vs. 125.5 ± 15.1 mmHg, p < 0.01). The brachial minus carotid SBP difference (amplification) did not differ in males vs. females (4.9 ± 6.3 and 5.9 ± 6.2 mmHg respectively, p = NS) or in hypertensives vs. normotensives (7.8 ± 4.4 and 4.8 ± 6.4 mmHg, p = NS) and was not associated with age (r = −0.05) or height (r = −0.13). Carotid and brachial office SBP were correlated to 24-hour ambulatory SBP (r = 0.75 and 0.83 respectively, both p < 0.05) and with each other (r = 0.93). 24-hour ambulatory, carotid and brachial office SBP were associated with all indices of preclinical organ damage (LVMI: r = 0.33, 0.22 and 0.28; cIMT: 0.47, 0.36 and 0.38; PWV: 0.55, 0.50 and 0.58 respectively; p = NS for comparisons of coefficients). Conclusions: These preliminary results suggest that in children and adolescents central BP assessed at the carotid artery with the Complior method is not superior to brachial office or ambulatory BP in terms of their association with preclinical organ damage.