Commentary: Peripheral and Central Aortic Pressure, Wave-Derived Reflection Parameters, Local and Regional Arterial Stif
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COMMENTARY
Commentary: Peripheral and Central Aortic Pressure, Wave‑Derived Reflection Parameters, Local and Regional Arterial Stiffness and Structural Parameters in Children and Adolescents: Impact of Body Mass Index Variations Marcelo Perim Baldo1 · Divanei A. Zaniqueli2 · José G. Mill2 Received: 29 June 2018 / Accepted: 1 July 2018 © Springer Nature Switzerland AG 2018
During the lifetime, we are exposed to several risk factors that gradually increase blood pressure (BP). This increase may be secondary to changes in both BP regulatory mechanisms or to a direct effect on structural properties of the vascular wall. The effects of these risk factors on vascular wall have been extensively studied in adults and elderly people [1, 2]. However, it is not quite clear their influence on BP levels in children and adolescents. In fact, the prevalence of high BP in this population has increased over the last decades [3]. Data on BP levels in children and adolescents are variable among different populations, and such differences have been related to different genetic background, ethnicity, nutritional status, and anthropometric variables. Analysis from the National Health and Nutrition Examination Survey (NHANES) showed that the body mass index (BMI), waist circumference and salt intake are all associated to increases in BP in individuals aged 8–17 years old. After controlling by age, ethnicity, sex, anthropometric variables and salt intake, the temporal trends for increase in BP levels disappear [4]. Also, pulse pressure (PP) has increased in parallel to the rise of obesity in children highlighting to changes in aortic function [5]. Based on the crescent prevalence of obesity and hypertension reported in the last decades for children and adolescents, studies have consistently shown increased risk for cardiovascular diseases in adults that were obese during childhood [6, 7]. The study published by Garcia-Espinosa * Marcelo Perim Baldo [email protected] 1
Department of Pathophysiology, Montes Claros State University - UNIMONTES, Av Dr Rui Braga, S/N, Vila Mauriceia, 39401‑089 Montes Claros, MG, Brazil
Department of Physiological Sciences, Federal University of Espírito Santo, Vitoria, Brazil
2
and collaborators [8] elegantly explored the association between variations in BMI with variations in central and peripheral hemodynamic and vascular structural parameters in children and adolescents. For that purpose, the authors used variations in standardized BMI (z-BMI score) as dependent variable and several standardized hemodynamic and vascular parameters as independent variables to better account for individual variations from the expected average levels for these associations. These individual variations were obtained by using a sub-group of children and adolescents without any cardiovascular risk factors, named as a “reference population”, making possible to compare how people from the general sample would deviate from the reference patterns. In their work, Garcia-Espinosa and collaborators [8] observed that
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