64 Reference Values of Aortic Pulse Wave Velocity in a Large Healthy Population Aged Between 3 and 18 Years Оригинальная статья Erzsebet Valeria Hidvegi 1 , Miklos Illyes 1 , Bela Benczur 1 , Renata M. Bocskei 1 , Laszlo Ratgeber 2 , Zsofia Lenkey 1 , Ferenc T. Molnar 3 , Attila Cziraki 1 1 Heart Institute, Faculty of Medicine, University of Pecs 2 Faculty of Health Sciences Institute of Public Health and Health Promotion, University of Pecs, Pecs 3 Department of Hydrodynamic Systems, Budapest University of Technology and Economics, Budapest, Hungary Objective. The measurement of aortic pulse wave velocity (PWV ao ) is an accepted marker in stratifying individual cardiovascular risk in adults. There is an increasing volume of evidence concerning impaired vascular function in different diseases in paediatric populations, but, unfortunately, only a few studies are available on the measurement of normal PWV ao values in children. The aim of our study was to determine the reference values of PWV ao in a large healthy population using a newly developed technique. Methods. Three thousand, three hundred and seventyfour healthy individuals (1802 boys) aged 3–18 years were examined by an invasively validated, occlusive, oscillometric device. Results. The mean PWV ao values increased from 5.5 ± 0.3 to 6.5 ± 0.3 m/s (p < 00.05) in boys and from 5.6 ± 0.3 to 6.4 ± 0.3 m/s (p < 0.05) in girls. The increase, however, was not constant, and the values exhibited a flat period between the ages of 3 and 8 years in both sexes. The first pronounced increase occurred at the age of 12.1 years in boys and 10.4 years in girls. Moreover, between the ages of 3 and 8 years, the brachial SBP and mean blood pressures increased continuously and gradually, whereas the PWV ao remained unchanged. By contrast, beyond the age of 9 years, blood pressure and aortic stiffness trends basically moved together. Conclusion. Our study provides the largest database to date concerning arterial stiffness in healthy children and adolescents between the ages of 3 and 18 years, and the technology adopted proved easy to use in large paediatric populations, even at a very young age. Abbreviations. CCA, common carotid artery; HR, heart rate; MAP, mean arterial pressure; PWV ao , aortic pulse wave velocity; RCA, right carotid artery; SSN, suprasternal notch; TEM, technical errors of measurement. Key words: aorta, Arteriograph, blood pressure, children and adolescents, pulse wave velocity. (Pediatricheskaya farmakologiya — Pediatric pharmacology. 2013; 10 (2): 64–71) Author for correspondence: Erzsebet Valeria Hidvegi, MD Address: Heart Institute, Faculty of Medicine, University of Pecs, 13 Ifjusag str., H-7624 Pecs, Hungary, tel.: +36 56 522 301, e-mail: pediatriccor@gmail.com Accepted: 17.02.2013, submitted for publication: 24.04.2013. INTRODUCTION The measurement of arterial stiffness, that is, aortic pulse wave velocity (PWV ao ), is an accepted marker for detecting organ damage and for stratifyingindividual cardiovascular risk in adults [1]. Moreover, we have an increasing volume of evidence concerning impaired vascular function in different diseases in paediatric populations: early athero- sclerosis [2], obesity [3], extreme prematurity [4], familial hypercholesterolemia [5, 6], type I diabetes mellitus [7,8], juvenile hypertension [9], different congenital heart diseases [10, 11], end-stage renal disease [12], HIV infection [13], Kawasaki disease [14], neurofibromatosis [15], vasculitis [16], intrauterine growth restriction patients [17] and primary snoring [18]. These diseases might well influence aortic stiffness, and so the measurement of PWV ao may provide useful information, even in a paediatric population. However, to be able to assess the measured PWV ao values in different conditions and, further, to assess age-related dynamic changes of PWV ao in children and adolescents — especially in younger populations of less than 6 years — a precise determination of reference values between the third and 97th percentile is extremely important. Unfortunately, few studies are available which detail the normal values of PWV ao in paediatric populations. To date, in fact, a total of 1514 healthy individuals have been studied in six articles [19–24] (Table 1). In the majority of these studies, relatively small populations (n < 140) were measured to provide control groups to the diseased populations studied, and it is also worth mentioning that these healthy control groups were remarkably imbalanced in terms of age distribution. Only one study [24] comprised a larger population (1008 individuals, 6–20 years), but even in this study the age distribution of the population was poorly balanced, as a substantial majority (68.1%) of the individuals studied were from the 15–20 years age group. On the contrary, these studies used ultrasound and applanation tonometry to determine PWV ao , techniques which are limited in use to the noninvasive clinical evaluation of aortic stiffness in paediatric patients [25]. The aim of our study, therefore, was to determine the reference values of the PWV ao in a large healthy Печатается по: J Hypertens. 2012; 30. PF2_2013.indd 64 PF2_2013.indd 64 14.05.2013 11:04:58 14.05.2013 11:04:58