Table Info

BP group	N	Mean CAVI	Median (IQR)	P-value
BP group (all ages)	Normal	70	4.94	5.0 (4.4–5.7)	0.7
Elevated	64	5.12	5.1 (4.5–5.6)
Stage I/II HTN	102	5.05	5.0 (4.3–5.5)
BP group (> 15 years)	Normal	22	5.40	5.33 (4.7–6.2)	0.9
Elevated	31	5.48	5.40 (5.3–6.0)
Stage I/II HTN	57	5.38	5.20 (4.7–5.9)

Declarations

Author contributions

EH: Conceptualization, Investigation, Formal analysis, Writing—original draft, Writing—review & editing. NDS, NZ, BH, and RN: Conceptualization, Investigation. BA: Conceptualization, Supervision, Writing—review & editing. RP: Conceptualization, Investigation, Formal analysis, Supervision, Writing—review & editing.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Approval for this study was obtained from the University of Tennessee Health Science Center institutional review board. This study was in compliance with the Declaration of Helsinki.

Consent to participate

Written informed consent to participate was appropriately obtained from all participants or their patients/legal guardians for children under 16.

Consent to publication

Not applicable.

Availability of data and materials

The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.

Funding

Not applicable.

Copyright

References

Falkner B, Gidding SS, Baker-Smith CM, Brady TM, Flynn JT, Malle LM, et al.; American Heart Association Council on Hypertension; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Kidney in Cardiovascular Disease; Council on Lifestyle and Cardiometabolic Health; and Council on Cardiovascular and Stroke Nursing. Pediatric primary hypertension: an underrecognized condition: a scientific statement from the american heart association. Hypertension. 2023;80:e101–11. [DOI] [PubMed]

Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA. 2007;298:874–9. [DOI] [PubMed]

Kaelber DC, Localio AR, Ross M, Leon JB, Pace WD, Wasserman RC, et al. Persistent hypertension in children and adolescents: a 6-year cohort study. Pediatrics. 2020;146:e20193778. [DOI] [PubMed] [PMC]

Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al.; SUBCOMMITTEE ON SCREENING AND MANAGEMENT OF HIGH BLOOD PRESSURE IN CHILDREN. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140:e20171904. Erratum in: Pediatrics. 2017;140:e20173035. Erratum in: Pediatrics. 2018;142:e20181739. [DOI] [PubMed]

Khoury M, Khoury PR, Dolan LM, Kimball TR, Urbina EM. Clinical implications of the revised AAP pediatric hypertension guidelines. Pediatrics. 2018;142:e20180245. [DOI] [PubMed] [PMC]

AlAbdulKader AM, Morse EF, Daley MF, Rao G. Pediatric hypertension: parent perspectives. Glob Pediatr Health. 2020;7:2333794X20981340. [DOI] [PubMed] [PMC]

Brady TM, Fivush B, Flynn JT, Parekh R. Ability of blood pressure to predict left ventricular hypertrophy in children with primary hypertension. J Pediatr. 2008;152:73–8.e1. [DOI] [PubMed]

Khoury M, Urbina EM. Cardiac and vascular target organ damage in pediatric hypertension. Front Pediatr. 2018;6:148. [DOI] [PubMed] [PMC]

Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37:1236–41. [DOI] [PubMed]

10.

Thijssen DH, Cable NT, Green DJ. Noninvasive assessment of subclinical atherosclerosis in children and adolescents. Hypertension. 2010;55:e14. [DOI] [PubMed]

11.

Reusz GS, Cseprekal O, Temmar M, Kis E, Cherif AB, Thaleb A, et al. Reference values of pulse wave velocity in healthy children and teenagers. Hypertension. 2010;56:217–24. [DOI] [PubMed]

12.

Kulsum-Mecci N, Goss C, Kozel BA, Garbutt JM, Schechtman KB, Dharnidharka VR. Effects of obesity and hypertension on pulse wave velocity in children. J Clin Hypertens (Greenwich). 2017;19:221–6. [DOI] [PubMed] [PMC]

13.

Ruiz-Moreno MI, Vilches-Perez A, Gallardo-Escribano C, Vargas-Candela A, Lopez-Carmona MD, Pérez-Belmonte LM, et al. Metabolically healthy obesity: presence of arterial stiffness in the prepubescent population. Int J Environ Res Public Health. 2020;17:6995. [DOI] [PubMed] [PMC]

14.

Ovchinnikov A, Filatova A, Potekhina A, Arefieva T, Gvozdeva A, Ageev F, et al. Blood immune cell alterations in patients with hypertensive left ventricular hypertrophy and heart failure with preserved ejection fraction. J Cardiovasc Dev Dis. 2023;10:310. [DOI] [PubMed] [PMC]

15.

Kumar V, Prabhu SD, Bansal SS. CD4⁺ T-lymphocytes exhibit biphasic kinetics post-myocardial infarction. Front Cardiovasc Med. 2022;9:992653. [DOI] [PubMed] [PMC]

16.

Karayiğit O, Nurkoç SG, Çelik MC. Systemic immune-inflammation index (SII) may be an effective indicator in predicting the left ventricular hypertrophy for patients diagnosed with hypertension. J Hum Hypertens. 2023;37:379–85. [DOI] [PubMed]

17.

Kumar V, Rosenzweig R, Asalla S, Nehra S, Prabhu SD, Bansal SS. TNFR1 contributes to activation-induced cell death of pathological CD4⁺ T lymphocytes during ischemic heart failure. JACC Basic Transl Sci. 2022;7:1038–49. [DOI] [PubMed] [PMC]

18.

Sun CK. Cardio-ankle vascular index (CAVI) as an indicator of arterial stiffness. Integr Blood Press Control. 2013;6:27–38. [DOI] [PubMed] [PMC]

19.

Matsushita K, Ding N, Kim ED, Budoff M, Chirinos JA, Fernhall B, et al. Cardio-ankle vascular index and cardiovascular disease: systematic review and meta-analysis of prospective and cross-sectional studies. J Clin Hypertens (Greenwich). 2019;21:16–24. [DOI] [PubMed] [PMC]

20.

Budoff MJ, Alpert B, Chirinos JA, Fernhall B, Hamburg N, Kario K, et al. Clinical applications measuring arterial stiffness: an expert consensus for the application of cardio-ankle vascular index. Am J Hypertens. 2022;35:441–53. [DOI] [PubMed] [PMC]

21.

Shirai K, Utino J, Otsuka K, Takata M. A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI). J Atheroscler Thromb. 2006;13:101–7. [DOI] [PubMed]

22.

Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Zampi I, Gattobigio R, et al. White coat hypertension and white coat effect similarities and differences. Am J Hypertens. 1995;8:790–8. [DOI] [PubMed]

23.

Jurko T, Mestanik M, Jurko A Jr, Spronck B, Avolio A, Mestanikova A, et al. Pediatric reference values for arterial stiffness parameters cardio-ankle vascular index and CAVI₀. J Am Soc Hypertens. 2018;12:e35–43. [DOI] [PubMed]

24.

Mestanik M, Jurko A, Mestanikova A, Jurko T, Tonhajzerova I. Arterial stiffness evaluated by cardio-ankle vascular index (CAVI) in adolescent hypertension. Can J Physiol Pharmacol. 2016;94:112–6. [DOI] [PubMed]

25.

Urbina EM, Khoury PR, McCoy CE, Dolan LM, Daniels SR, Kimball TR. Triglyceride to HDL-C ratio and increased arterial stiffness in children, adolescents, and young adults. Pediatrics. 2013;131:e1082–90. Erratum in: Pediatrics. 2013;132:780. [DOI] [PubMed] [PMC]

26.

Bramwell JC, Hill AV. The velocity of pulse wave in man. Proc R Soc Lond B. 1922;93:298–306. [DOI]

27.

Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the pediatric measurements writing group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr. 2010;23:465–95. [DOI] [PubMed]

28.

Khoury PR, Mitsnefes M, Daniels SR, Kimball TR. Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr. 2009;22:709–14. [DOI] [PubMed]

29.

Spronck B, Avolio AP, Tan I, Butlin M, Reesink KD, Delhaas T. Arterial stiffness index beta and cardio-ankle vascular index inherently depend on blood pressure but can be readily corrected. J Hypertens. 2017;35:98–104. [DOI] [PubMed]

30.

Giudici A, Khir AW, Reesink KD, Delhaas T, Spronck B. Five years of cardio-ankle vascular index (CAVI) and CAVI₀: how close are we to a pressure-independent index of arterial stiffness? J Hypertens. 2021;39:2128–38. [DOI] [PubMed]

31.

Sharma AP, Mohammed J, Thomas B, Lansdell N, Norozi K, Filler G. Nighttime blood pressure, systolic blood pressure variability, and left ventricular mass index in children with hypertension. Pediatr Nephrol. 2013;28:1275–82. [DOI] [PubMed]

32.

Flynn JT, Urbina EM, Brady TM, Baker-Smith C, Daniels SR, Hayman LL, et al.; Atherosclerosis, Hypertension, and Obesity in the Young Committee of the American Heart Association Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Cardiovascular Radiology and Intervention; Council on Epidemiology and Prevention. Ambulatory blood pressure monitoring in children and adolescents: 2022 update: a scientific statement from the American Heart Association. Hypertension. 2022;79:e114–24. [DOI] [PubMed]

33.

Butler JE, Vincent C, South AM, Chanchlani R. Updates to pediatric ambulatory blood pressure monitoring in clinical practice: a review and strategies for expanding access. Curr Pediatr Rep. 2022;10:172–81. [DOI]

34.

Philip R, Alpert BS, Schwingshackl A, Huang X, Blakely D, Rovnaghi CR, et al. Inverse relationship between cardio-ankle vascular index and body mass index in healthy children. J Pediatr. 2015;167:361–5.e1. [DOI] [PubMed]

35.

Corden B, Keenan NG, de Marvao AS, Dawes TJ, Decesare A, Diamond T, et al. Body fat is associated with reduced aortic stiffness until middle age. Hypertension. 2013;61:1322–7. [DOI] [PubMed]