Systemic stiffness: a determinant of blood pressure?

1
Systemic stiffness a determinant of blood
pressure?

• Cuno Uiterwaal Julius Centre
• Rick Grobbee Julius Centre
• Ralph Sakkers Paediatric orthopedics
• Paul Helders Child Physical therapy
• Ruud Bank TNO/LUMC
• Raoul Engelbert Child Physical therapy

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Background blood pressure

• early life origin of primary hypertension
• blood pressure - arterial wall stiffness
• arterial wall stiffness - atherosclerosis
• arterial wall stiffness - clinical disease
• blood pressure - connective tissue vascular wall

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Background

• Blood pressure partly determined by
• vessel wall connective tissue metabolism
• only localized metabolism or systemic?

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Background

• Connective tissue collagen, elastin,
• crosslinks
• many different forms
• tissue specific composition/metabolism
• some similarities in different tissues

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Childhood hypermobility syndromes

• Part of diagnostic tools
• Joint hypermobility
• skin hyperextensibility

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Background

• joint mobility and cardiovascular disease
• limited in diabetes mellitus (microangiopathy?)
• limited in hypertensives??
• very little research
• skin extensibility
• no research

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Research question general

• Is the relation between blood pressure and
  tissue stiffness confined to the ardiovascular
  system?

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Research question specific

• Is blood pressure related to
• joint mobility
• skin extensibility
• muscle strength
• bone quality
• in prepubertal children?

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Childhood determinants of blood pressure

• Age
• gender
• body height
• body weight
• family BP levels

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Childhood determinants of joint mobility/skin
extensibility

• age
• gender
• body height
• body weight
• family levels
• race

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Study design subjects

• Cross-section of 95 Caucasian children
• two primary school in Zeist (NL)
• examined November 2000

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Study design measurements

• anthropometry
• blood pressure (OMRON)
• joint mobility goniometry
• skin extensibility standard vacuum pressure
• muscle strength score
• bone quality ultrasound os calcis
• questionnaires

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General characteristics
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Median (range) joint motion left
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Median (range) skin extensibility left
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Blood pressure and systemic stiffness
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Adjustment age, gender, weight, height
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Mutual dependence of various organs
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Discussion

• underpowered study
• selection/information bias?
• reverse causality?
• unknown or residual confounding?

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Conclusions

• Part of the relation between blood pressure and
  tissue stiffness may be systemic