CENTRAL BLOOD PRESSURE MEASUREMENT IN CHILDREN AND ADOLESCENTS: SYSTEMATIC REVIEW

Abstract

Objective: Central aortic blood pressure (BP) has attracted the researchers interest due to its potential to improving cardiovascular risk stratification. We reviewed the published data on central BP in children and adolescents excluding those with chronic heart, lung or kidney disease, congenital anomaly or syndrome, malignancy, and acute illness. Design and method: A systematic review of literature based on PubMed database was conducted by two independent researchers up to January 2021 in accordance with the PRISMA guidelines. Additional studies were identified from the reference lists of relevant articles. Results: A total of 56 eligible articles were identified (Table). The available literature advocates a positive association between male gender, age, height, African-American descent, preterm birth, hypertension and diabetes with central BP, whereas the association of birth weight and physical exercise with central BP was inverse. Regarding the relationship of central BP with indices of preclinical target organ damage, 11 studies showed a positive association with pulse wave velocity, 7 with left ventricular mass index, 5 with carotid intima-media thickness, and 4 with augmentation index. Two studies reported an inverse association with the equivalent of the central retinal artery. The studies testing non-invasive techniques for central BP estimation reported that they approach the invasive technique with adequate accuracy, with crucial impact of the calibration method. Tonometry remains the most studied non-invasive measurement method, followed by oscillometry. Two studies provided normalcy values using the oscillometric method. The evidence on 24-hour ambulatory central BP is limited. Conclusions: The evidence on central BP measurement in youth is limited and derived from non-invasive evaluation in static conditions using tonometry. Central BP in children and adolescents seems to be affected by multiple factors and is associated with preclinical target organ damage.