Large vessels in hypertension: central blood pressure

Abstract

Children and adolescents with high normal blood pressure and/or high arterial stiffness have a high risk for developing hypertension. Modifiable cardiovascular risk factors, such as dietary salt intake, fructose, and lifestyles including food sources—processed and fast foods—, sleep patterns, stress, and reductions in physical activity, play a crucial role in the transition between high-normal BP and hypertension. In this review, we will analyze the epidemiological and hemodynamic evidence that increased arterial stiffness is a determinant of incident hypertension. We will also address the complexity of this relationship by discussing the hemodynamic and biomechanical pathways involved in the bidirectional influence between arterial stiffness and blood pressure. And then, we will discuss how the concept of early vascular ageing—EVA—can help in understanding the relationship between arterial stiffness and high-normal BP. Finally, we will apply these concepts to the relationship between metabolic syndrome, arterial stiffness and high-normal BP in children. We will demonstrate that it is of crucial importance to increase physical activity and reduce obesity in children in order to reduce arterial stiffness, and thus, decrease the prevalence of high BP in childhood