Childhood Obesity Associates Haemodynamic and Vascular Changes That Result in Increased Central Aortic Pressure with Augmented Incident and Reflected Wave Components, without Changes in Peripheral Amplification

Abstract

The aims were to determine if childhood obesity is associated with increased central aortic blood pressure (BP) and to characterize haemodynamic and vascular changes associated with BP changes in obese children and adolescents by means of analyzing changes in cardiac output (stroke volume, SV), arterial stiffness (aortic pulse wave velocity, PWV), peripheral vascular resistances (PVR), and net and relative contributions of reflected waves to the aortic pulse wave amplitude. We included 117 subjects (mean/range age: 10 (5–15) years, 49 females), who were obese (OB) or had normal weight (NW). Peripheral and central aortic BP, PWV, and pulse wave-derived parameters (augmentation index, amplitude of forward and backward components) were measured with tonometry (SphygmoCor) and oscillometry (Mobil-O-Graph). With independence of the presence of dyslipidemia, hypertension, or sedentarism, the aortic systolic and pulse BP were higher in OB than in NW subjects. The increase in central BP could not be explained by the elevation in the relative contribution of reflections to the aortic pressure wave and higher PVR or by an augmented peripheral reflection coefficient. Instead, the rise in central BP could be explained by an increase in the amplitude of both incident and reflect wave components associated to augmented SV and/or PWV.

Reference Intervals of Central Aortic Blood Pressure and Augmentation Index Assessed with an Oscillometric Device in Healthy Children, Adolescents, and Young Adults from Argentina

“…Otherwise, AS and arrival time and amplitude of wave reflections are the main determinants of cSBP and cPP, while peripheral vascular resistances and cardiac output are the main determinants of MBP and cDBP. In this context, it is important to emphasize that simultaneous measurements of central (aortic) BP and cAIx (using a single device) in children and adolescents allow us not only to know if cSBP and cPP are within physiological levels, but also in case of abnormal values to realize if they were associated or not with increased wave reflection levels (cAIx) [ 31 , 32 ].…”

Children and Adolescent Obesity Associates with Pressure-Dependent and Age-Related Increase in Carotid and Femoral Arteries’ Stiffness and Not in Brachial Artery, Indicative of Nonintrinsic Arterial Wall Alteration

“…In relation with this, it has been suggested that childhood obesity may lead to hemodynamic changes, with an increased systemic blood flow that responds to changes in the ventricular function, as an adaptative mechanism that could contribute to explaining the increase in the arterial working diameters [ 3 , 26 , 27 ]. In relation to this, in a recent work of our group in which noninvasive methods were employed, obese children and adolescents showed increased left ventricle stroke volume and cardiac output [ 28 ].…”

Changes in aortic pulse wave components, pulse pressure amplification, and hemodynamic parameters of children and adolescents with type 1 diabetes

“…The PWV was determined by means of a mathematical model, considering several parameters in the pulse wave and wave separation analysis. The AIx@75 was calculated by means of the pressure difference between the reflection wave peak (P2) and the incident wave peak (P1), expressed as the PPc percentage [AIx@75 = (P2 − P1)/PPc × 100] . In addition to the indices of arterial stiffness, the peripheral arterial pressure (systolic blood pressure [SBPp], diastolic blood pressure [DBPp], and pulse pressure [PPp]) and central arterial pressure (SBPc, DBPc, and PPc), and mean arterial pressure were evaluated.…”