LAUSR

Objective: Carotid wall intima-media thickness (cIMT) is an established surrogate measure of preclinical target-organ damage. Accumulating evidence suggests that central (aortic) blood pressure (BP) may reflect the hemodynamic stress on target organs more accurately than brachial BP. This study investigated the associations between 24-hour brachial versus central ambulatory BP (ABP) with cIMT in adolescents and young adults. Design and method: Apparently healthy adolescents and young adults (age 11–26 years) referred for elevated BP and healthy volunteers were subjected to: (i) 24-hour brachial and central (calibration with mean and diastolic brachial BP) ABP monitoring using a noninvasive brachial cuff-based oscillometric device (Mobil-O-Graph 24 h PWA) (ii) cIMT measurement (high resolution B-mode ultrasonography) at the level of common carotid and bulb bilaterally. Results: Data from 127 subjects were analyzed (mean age 17.9 ± 4.7 years, 96 males, body mass index [BMI] 24.9 ± 5.0 kg/m2, 34 volunteers, 40 with elevated 24-hour ABP [> = 95th percentile for adolescents or > = 130/80 mmHg for adults]). There was a strong association between 24-hour central and brachial systolic ABP (r = 0.80, p < 0.01), yet the latter was lower by 6.7 ± 8.4 mmHg (95% confidence intervals −8.2, −5.2, p < 0.01). cIMT was more closely associated with central than brachial systolic ABP (r = 0.52 vs. 0.34, p < 0.01 for difference). In stepwise multivariate regression analysis (independent variables: age, gender, BMI, central and brachial systolic ABP), cIMT was determined by central systolic ABP and male gender (R2 = 0.32). Conclusions: In young individuals central ABP appears to be a stronger determinant of early carotid damage that conventional brachial ABP.