Differences between brachial and aortic blood pressure in adolescence and their implications for diagnosis of hypertension

Alun D Hughes; George Davey Smith; Laura D Howe; Deborah Lawlor; Siana Jones; Chloe M Park; Nish Chaturvedi

doi:10.1097/HJH.0000000000003743

Differences between brachial and aortic blood pressure in adolescence and their implications for diagnosis of hypertension

J Hypertens. 2024 Apr 16. doi: 10.1097/HJH.0000000000003743. Online ahead of print.

Authors

Alun D Hughes¹, George Davey Smith², Laura D Howe², Deborah Lawlor², Siana Jones¹, Chloe M Park¹, Nish Chaturvedi¹

Affiliations

¹ MRC Unit for Lifelong Health & Ageing, Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London.
² MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK.

PMID: 38660719
DOI: 10.1097/HJH.0000000000003743

Abstract

Objectives: Blood pressure (BP) is the leading global cause of mortality, and its prevalence is increasing in children and adolescents. Aortic BP is lower than brachial BP in adults. We aimed to assess the extent of this difference and its impact on the diagnosis of hypertension among adolescents.

Methods: We used data from 3850 participants from a UK cohort of births in the early 1990s in the Southwest of England, who attended their ∼17-year follow-up and had valid measures of brachial and aortic BP at that clinic [mean (SD) age 17.8 (0.4) years, 66% female individuals]. Data are presented as mean differences [95% prediction intervals] for both sexes.

Results: Aortic systolic BP (SBP) was lower than brachial SBP [male, -22.3 (-31.2, -13.3) mmHg; female, -17.8 (-25.5, -10.0) mmHg]. Differences between aortic and brachial diastolic BP (DBP) were minimal. Based on brachial BP measurements, 101 male individuals (6%) and 22 female individuals (1%) were classified as hypertensive. In contrast, only nine male individuals (<1%) and 14 female individuals (<1%) met the criteria for hypertension based on aortic BP, and the predictive value of brachial BP for aortic hypertension was poor (positive-predictive value = 13.8%). Participants with aortic hypertension had a higher left ventricular mass index than those with brachial hypertension.

Conclusion: Brachial BP substantially overestimates aortic BP in adolescents because of marked aortic-to-brachial pulse pressure amplification. The use of brachial BP measurement may result in an overdiagnosis of hypertension during screening in adolescence.