Abstract
Unlike in older people, it has been suggested that elevated blood pressure (BP) in young people is because of high cardiac output accompanied by normal total peripheral resistance (TPR)-a hyperkinetic/hyperdynamic circulation. We investigated this in a large, United Kingdom-based birth cohort of adolescents. The study was conducted on 2091 17-year-old participants in the ALSPAC (Avon Longitudinal Study of Parents and Children)-a prospective population-based birth cohort study. BP measurement and echocardiography were performed, and heart rate (HR), stroke volume (SV), and TPR were calculated. Data are means (SD). Higher quintiles of systolic BP were associated with higher SV, higher HR, and higher TPR. The proportional contribution made by SV, HR, and TPR to mean arterial pressure differed little by systolic BP quintile (SV [32%-34%], HR [25%-29%], and TPR [39%-41%]). Higher BP is attributable to a combination of higher cardiac output (ie, SV×HR) and higher TPR in a population-based sample of adolescents. There is no evidence of a disproportionate contribution from elevated cardiac output at higher BP levels.
Highlights
Unlike in older people, it has been suggested that elevated blood pressure (BP) in young people is because of high cardiac output accompanied by normal total peripheral resistance (TPR)—a hyperkinetic/hyperdynamic circulation
Elevated BP is associated with increased left ventricular (LV) mass and LV hypertrophy in adults[7] and children.[8]
Several previous studies[15,16,17] have suggested that high BP in young people may be explained by elevated cardiac output (CO) rather than elevated TPR, whereas the latter is more typical in older people with established hypertension.[17]
Summary
It has been suggested that elevated blood pressure (BP) in young people is because of high cardiac output accompanied by normal total peripheral resistance (TPR)—a hyperkinetic/hyperdynamic circulation We investigated this in a large, United Kingdom-based birth cohort of adolescents. Elevated blood pressure (BP) accounts for two thirds of all strokes and a half of all coronary heart diseases, and the relationship between BP and risk is continuous and log-linear across the range of BP.[1] BP tracks from adolescence into adulthood,[2,3] and BP measured in adolescence is a predictor of cardiovascular events and renal disease ≤50 years later.[4,5,6] Elevated BP is associated with increased left ventricular (LV) mass and LV hypertrophy in adults[7] and children.[8] Increased LV mass and hypertrophy are associated with subsequent cardiovascular risk, independent of other risk factors, including BP.[9,10,11,12,13,14] Mean arterial pressure (MAP) in excess of right atrial pressure is the driving force for flow in the systemic circulation and is determined by cardiac output (CO; calculated as stroke volume [SV]×heart rate [HR])×total peripheral resistance (TPR) of the systemic circulation. We aimed to investigate whether higher BP in young people is explained by a hyperkinetic state and whether elevated HR and SV made a disproportionate contribution to elevated BP in a large, population-based cohort of adolescents
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