Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
Am J Physiol Heart Circ Physiol. 2023 Jun 1;324(6):H776-H781. doi: 10.1152/ajpheart.00094.2023. Epub 2023 Mar 17.
There is limited understanding of the role of arterial stiffness in cardiovascular disease risk in the pediatric population, lagging behind strong evidence in the adult population. Arterial stiffness progression among adolescents with hypertension has been considered hypertension-mediated vascular damage. However, emerging pediatric reports suggest that arterial stiffness may precede increased blood pressure and hypertension, whereas increased blood pressure from childhood has been associated with signs of cardiac damage in mid-adulthood. Thus, this study used a third variable analytical approach to examine whether arterial stiffness mediates or suppresses the effects of increasing blood pressure on cardiac structure and function in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort of 1,778 adolescents. After an adjustment for cardiometabolic and lifestyle factors, arterial stiffness measured as carotid-femoral pulse wave velocity partly suppressed the association of higher systolic blood pressure with higher left ventricular mass (standardized regression coefficient, β = -0.012; = 0.017; suppression effect = 4%), partly mediated the associations of higher systolic and diastolic blood pressure with higher relative ventricular wall thickness, and partly suppressed the association of higher diastolic blood pressure with lower left ventricular diastolic function (β = -0.021; = 0.003; suppression effect = 14.5%). In conclusion, increasing arterial stiffness could attenuate some of the adverse effects of increased blood pressure on cardiac structure and function in adolescents possibly by modifying the Windkessel effects. The present study demonstrates that the associations of blood pressure with cardiac function and structure in adolescents may be mediated or suppressed by arterial stiffness depending on the blood pressure phenotype: systolic or diastolic. Arterial stiffness may be considered as an intermediate pathway to attenuate the effect of increased blood pressure on altered cardiac structure and function in youth.
人们对动脉僵硬在儿科人群中心血管疾病风险中的作用了解有限，这落后于成人人群中的有力证据。高血压青少年的动脉僵硬进展被认为是高血压介导的血管损伤。然而，新出现的儿科报告表明，动脉僵硬可能先于血压升高和高血压，而儿童期的血压升高与中年期心脏损伤的迹象有关。因此，本研究使用第三变量分析方法，在阿冯纵向研究父母和儿童（ALSPAC）队列的 1778 名青少年中，检查动脉僵硬是否介导或抑制血压升高对心脏结构和功能的影响。在调整了心血管代谢和生活方式因素后，颈动脉-股动脉脉搏波速度测量的动脉僵硬部分抑制了较高收缩压与较高左心室质量之间的关联（标准化回归系数，β=-0.012； =0.017；抑制效应=4%），部分介导了较高收缩压和舒张压与较高相对心室壁厚度之间的关联，部分抑制了较高舒张压与较低左心室舒张功能之间的关联（β=-0.021； =0.003；抑制效应=14.5%）。总之，动脉僵硬的增加可能通过改变风箱效应来减轻血压升高对青少年心脏结构和功能的一些不利影响。本研究表明，血压与青少年心脏功能和结构之间的关联可能受动脉僵硬的介导或抑制，这取决于血压表型：收缩压或舒张压。动脉僵硬可被视为一种中间途径，以减轻血压升高对年轻人心脏结构和功能改变的影响。
