Arterial stiffness represents an independent predictor of the risk of subsequent cardiovascular events. Early identification of high-risk individuals is necessary for effective prevention and targeted interventions. Carotid wall echo-tracking is a modern method for an accurate evaluation of the structural and functional properties of carotid arteries. This study aimed to assess age and sex-specific reference values of the echo-tracking parameters of carotid stiffness in 400 healthy children and adolescents and to evaluate the potential early effect of elevated blood pressure and overweight in 69 overweight normotensives, 45 white coat hypertensives, and 44 essential hypertensives. Stiffness index β, pressure-strain elastic modulus (Ep), arterial compliance (AC), and pulse wave velocity β (PWV β) were evaluated using Aloka ProSound F75. Both white coat and essential hypertension were associated with impaired carotid wall properties with the greatest effect on Ep, followed by PWV β, index β, and AC. The excess weight showed a weaker effect on Ep and PWV β. This is the first study to compare the effects of white coat and essential hypertension on carotid arterial stiffness assessed using the echo-tracking technique in childhood and adolescence with direct application of pediatric reference values specific to age and sex.

Clinic of Children and Adolescents Jessenius Faculty of Medicine in Martin Comenius University in Bratislava University Hospital Martin Kollarova 2 03659 Martin Slovakia

Clinic of Neonatology Jessenius Faculty of Medicine in Martin Comenius University in Bratislava University Hospital Martin Kollarova 2 03659 Martin Slovakia

Clinic of Radiology Jessenius Faculty of Medicine in Martin Comenius University in Bratislava University Hospital Martin Kollarova 2 03659 Martin Slovakia

Department of Pediatrics Faculty of Medicine and Dentistry Palacky University University Hospital Olomouc Zdravotniku 248 7 77900 Olomouc Czech Republic

Department of Radiodiagnostics DONsP L N Jege Hospital Dolny Kubin Nemocnicna 1944 10 02614 Dolny Kubin Slovakia

Pediatric Cardiology Clinic Kollarova 13 03601 Martin Slovakia

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De Ferranti S.D., Steinberger J., Ameduri R., Baker A., Gooding H., Kelly A.S., Mietus-Snyder M., Mitsnefes M.M., Peterson A.L., St-Pierre J., et al. Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association. Circulation. 2019;139:E603–E634. doi: 10.1161/CIR.0000000000000618. PubMed DOI

Ferreira I., Van De Laar R.J., Prins M.H., Twisk J.W., Stehouwer C.D. Carotid Stiffness in Young Adults: A Life-Course Analysis of Its Early Determinants: The Amsterdam Growth and Health Longitudinal Study. Hypertension. 2012;59:54–61. doi: 10.1161/HYPERTENSIONAHA.110.156109. PubMed DOI

Jacobs D.R., Woo J.G., Sinaiko A.R., Daniels S.R., Ikonen J., Juonala M., Kartiosuo N., Lehtimäki T., Magnussen C.G., Viikari J.S.A., et al. Childhood Cardiovascular Risk Factors and Adult Cardiovascular Events. N. Engl. J. Med. 2022;386:1888. doi: 10.1056/NEJMoa2109191. PubMed DOI PMC

Teixeira R., Vieira M.J., Gonçalves A., Cardim N., Gonçalves L. Ultrasonographic Vascular Mechanics to Assess Arterial Stiffness: A Review. Eur. Heart J. Cardiovasc. Imaging. 2016;17:233–246. doi: 10.1093/ehjci/jev287. PubMed DOI

Wang K.L., Cheng H.M., Chuang S.Y., Spurgeon H.A., Ting C.T., Lakatta E.G., Yin F.C.P., Chou P., Chen C.H. Central or Peripheral Systolic or Pulse Pressure: Which Best Relates to Target Organs and Future Mortality? J. Hypertens. 2009;27:461–467. doi: 10.1097/HJH.0b013e3283220ea4. PubMed DOI PMC

Van Der Heijden-Spek J.J., Staessen J.A., Fagard R.H., Hoeks A.P., Struijker Boudier H.A., Van Bortel L.M. Effect of Age on Brachial Artery Wall Properties Differs from the Aorta and Is Gender Dependent: A Population Study. Hypertension. 2000;35:637–642. doi: 10.1161/01.HYP.35.2.637. PubMed DOI

Pewowaruk R.J., Korcarz C., Tedla Y., Burke G., Greenland P., Wu C., Gepner A.D. Carotid Artery Stiffness Mechanisms Associated With Cardiovascular Disease Events and Incident Hypertension: The Multi-Ethnic Study of Atherosclerosis (MESA) Hypertension. 2022;79:659–666. doi: 10.1161/HYPERTENSIONAHA.121.18772. PubMed DOI PMC

Agbaje A.O. Arterial Stiffness Precedes Hypertension and Metabolic Risks in Youth: A Review. J. Hypertens. 2022;40:1887–1896. doi: 10.1097/HJH.0000000000003239. PubMed DOI

Uejima T., Dunstan F.D., Arbustini E., Łoboz-Grudzień K., Hughes A.D., Carerj S., Favalli V., Antonini-Canterin F., Vriz O., Vinereanu D., et al. Age-Specific Reference Values for Carotid Arterial Stiffness Estimated by Ultrasonic Wall Tracking. J. Hum. Hypertens. 2020;34:214–222. doi: 10.1038/s41371-019-0228-5. PubMed DOI PMC

Urbina E.M., Khoury P.R., Mccoy C., Daniels S.R., Kimball T.R., Dolan L.M. Cardiac and Vascular Consequences of Pre-Hypertension in Youth. J. Clin. Hypertens. 2011;13:332–342. doi: 10.1111/j.1751-7176.2011.00471.x. PubMed DOI PMC

Skrzypczyk P., Zacharzewska A., Szyszka M., Ofiara A., Pańczyk-Tomaszewska M. Arterial Stiffness in Children with Primary Hypertension Is Related to Subclinical Inflammation. Cent. Eur. J. Immunol. 2021;46:336–343. doi: 10.5114/ceji.2021.109156. PubMed DOI PMC

Núñez F., Martínez-Costa C., Sánchez-Zahonero J., Morata J., Javier Chorro F., Brines J. Carotid Artery Stiffness as an Early Marker of Vascular Lesions in Children and Adolescents with Cardiovascular Risk Factors. Rev. Esp. Cardiol. 2010;63:1253–1260. doi: 10.1016/S0300-8932(10)70295-5. PubMed DOI

Cote A.T., Phillips A.A., Harris K.C., Sandor G.G.S., Panagiotopoulos C., Devlin A.M. Obesity and Arterial Stiffness in Children: Systematic Review and Meta-Analysis. Arterioscler. Thromb. Vasc. Biol. 2015;35:1038–1044. doi: 10.1161/ATVBAHA.114.305062. PubMed DOI

Doyon A., Kracht D., Bayazit A.K., Deveci M., Duzova A., Krmar R.T., Litwin M., Niemirska A., Oguz B., Schmidt B.M.W., et al. Carotid Artery Intima-Media Thickness and Distensibility in Children and Adolescents: Reference Values and Role of Body Dimensions. Hypertension. 2013;62:550–556. doi: 10.1161/HYPERTENSIONAHA.113.01297. PubMed DOI

Hanevold C.D. White Coat Hypertension in Children and Adolescents. Hypertension. 2019;73:24–30. doi: 10.1161/HYPERTENSIONAHA.118.11172. PubMed DOI

Cole T.J., Lobstein T. Extended International (IOTF) Body Mass Index Cut-Offs for Thinness, Overweight and Obesity. Pediatr. Obes. 2012;7:284–294. doi: 10.1111/j.2047-6310.2012.00064.x. PubMed DOI

Lurbe E., Cifkova R., Cruickshank J.K., Dillon M.J., Ferreira I., Invitti C., Kuznetsova T., Laurent S., Mancia G., Morales-Olivas F., et al. Management of High Blood Pressure in Children and Adolescents: Recommendations of the European Society of Hypertension. J. Hypertens. 2009;27:1719–1742. doi: 10.1097/HJH.0b013e32832f4f6b. PubMed DOI

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics. 2004;114:555–576. doi: 10.1542/peds.114.S2.555. PubMed DOI

Magda S.L., Ciobanu A.O., Florescu M., Vinereanu D. Comparative Reproducibility of the Noninvasive Ultrasound Methods for the Assessment of Vascular Function. Heart Vessels. 2013;28:143–150. doi: 10.1007/s00380-011-0225-2. PubMed DOI

Oliveira A.C., Cunha P.M.G.M., Vitorino P.V.d.O., Souza A.L.L., Deus G.D., Feitosa A., Barbosa E.C.D., Gomes M.M., Jardim P.C.B.V., Barroso W.K.S. Vascular Aging and Arterial Stiffness. Arq. Bras. Cardiol. 2022;119:604–615. doi: 10.36660/abc.20210708. PubMed DOI PMC

Ershova A.I., Meshkov A.N., Rozhkova T.A., Kalinina M.V., Deev A.D., Rogoza A.N., Balakhonova T.V., Boytsov S.A. Carotid and Aortic Stiffness in Patients with Heterozygous Familial Hypercholesterolemia. PLoS ONE. 2016;11:e0158964. doi: 10.1371/journal.pone.0158964. PubMed DOI PMC

Boutouyrie P., Chowienczyk P., Humphrey J.D., Mitchell G.F. Arterial Stiffness and Cardiovascular Risk in Hypertension. Circ. Res. 2021;128:864–886. doi: 10.1161/CIRCRESAHA.121.318061. PubMed DOI

Palombo C., Kozakova M., Guraschi N., Bini G., Cesana F., Castoldi G., Stella A., Morizzo C., Giannattasio C. Radiofrequency-Based Carotid Wall Tracking: A Comparison between Two Different Systems. J. Hypertens. 2012;30:1614–1619. doi: 10.1097/HJH.0b013e328354dd44. PubMed DOI

Moretti J.B., Michael R., Gervais S., Alchourron É., Stein N., Farhat Z., Lapierre C., Dubois J., El-Jalbout R. Normal Pediatric Values of Carotid Artery Intima-Media Thickness Measured by B-Mode Ultrasound and Radiofrequency Echo Tracking Respecting the Consensus: A Systematic Review. Eur. Radiol. 2023;34:654–661. doi: 10.1007/s00330-023-09994-2. PubMed DOI

Calabrò M.P., Carerj S., Russo M.S., De Luca F.L., Onofrio M.T.N., Antonini-Canterin F., Zito C., Oreto L., Manuri L., Khandheria B.K., et al. Carotid Artery Intima-Media Thickness and Stiffness Index β Changes in Normal Children: Role of Age, Height and Sex. J. Cardiovasc. Med. 2017;18:19–27. doi: 10.2459/JCM.0000000000000295. PubMed DOI

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;94:112–116. doi: 10.1139/cjpp-2015-0147. PubMed DOI

Jurko A., Jurko T., Minarik M., Mestanik M., Mestanikova A., Micieta V., Visnovcova Z., Tonhajzerova I. Endothelial Function in Children with White-Coat Hypertension. Heart Vessels. 2018;33:657–663. doi: 10.1007/s00380-017-1107-z. PubMed DOI

Jurko T., Mestanik M., Mestanikova A., Zeleňák K., Jurko A. Early Signs of Microvascular Endothelial Dysfunction in Adolescents with Newly Diagnosed Essential Hypertension. Life. 2022;12:1048. doi: 10.3390/life12071048. PubMed DOI PMC

Litwin M., Niemirska A., Ruzicka M., Feber J. White Coat Hypertension in Children: Not Rare and Not Benign? J. Am. Soc. Hypertens. 2009;3:416–423. doi: 10.1016/j.jash.2009.10.002. PubMed DOI

Lande M.B., Meagher C.C., Fisher S.G., Belani P., Wang H., Rashid M. Left Ventricular Mass Index in Children with White Coat Hypertension. J. Pediatr. 2008;153:50–54. doi: 10.1016/j.jpeds.2008.01.025. PubMed DOI PMC

Páll D., Juhász M., Lengyel S., Molnár C., Paragh G., Fülesdi B., Katona É. Assessment of Target-Organ Damage in Adolescent White-Coat and Sustained Hypertensives. J. Hypertens. 2010;28:2139–2144. doi: 10.1097/HJH.0b013e32833cd2da. PubMed DOI

Jurko A., Minarik M., Jurko T., Tonhajzerova I. White Coat Hypertension in Pediatrics. Ital. J. Pediatr. 2016;42:4. doi: 10.1186/s13052-016-0213-3. PubMed DOI PMC

Cohen J.B., Lotito M.J., Trivedi U.K., Denker M.G., Cohen D.L., Townsend R.R. Cardiovascular Events and Mortality in White Coat Hypertension: A Systematic Review and Meta-Analysis. Ann. Intern. Med. 2019;170:853–862. doi: 10.7326/M19-0223. PubMed DOI PMC

Saunders A., Nuredini G.N., Kirkham F.A., Drazich E., Bunting E., Rankin P., Ali K., Okorie M., Rajkumar C. White-Coat Hypertension/Effect Is Associated with Higher Arterial Stiffness and Stroke Events. J. Hypertens. 2022;40:758–764. doi: 10.1097/HJH.0000000000003073. PubMed DOI

Mestanik M., Jurko A., Spronck B., Avolio A.P., Butlin M., Jurko T., Visnovcova Z., Mestanikova A., Langer P., Tonhajzerova I. Improved Assessment of Arterial Stiffness Using Corrected Cardio-Ankle Vascular Index (CAVI0) in Overweight Adolescents with White-Coat and Essential Hypertension. Scand J Clin. Lab. Investig. 2017;77:665–672. doi: 10.1080/00365513.2017.1397286. PubMed DOI

Corden B., Keenan N.G., de Marvao A.S.M., Dawes T.J.W., Decesare A., Diamond T., Durighel G., Hughes A.D., Cook S.A., O’Regan D.P. Body Fat Is Associated with Reduced Aortic Stiffness until Middle Age. Hypertension. 2013;61:1322–1327. doi: 10.1161/HYPERTENSIONAHA.113.01177. PubMed DOI

Charakida M., Jones A., Falaschetti E., Khan T., Finer N., Sattar N., Hingorani A., Lawlor D.A., Smith G.D., Deanfield J.E. Childhood Obesity and Vascular Phenotypes. J. Am. Coll Cardiol. 2012;60:2643–2650. doi: 10.1016/j.jacc.2012.08.1017. PubMed DOI

Skrzypczyk P., Pańczyk-Tomaszewska M. Methods to Evaluate Arterial Structure and Function in Children—State-of-the Art Knowledge. Adv. Med. Sci. 2017;62:280–294. doi: 10.1016/j.advms.2017.03.001. PubMed DOI

Hamrahian S.M., Falkner B. Approach to Hypertension in Adolescents and Young Adults. Curr. Cardiol. Rep. 2022;24:131–140. doi: 10.1007/s11886-021-01632-x. PubMed DOI

Burgner D.P., Cooper M.N., Moore H.C., Stanley F.J., Thompson P.L., De Klerk N.H., Carter K.W. Childhood Hospitalisation with Infection and Cardiovascular Disease in Early-Mid Adulthood: A Longitudinal Population-Based Study. PLoS ONE. 2015;10:e0125342. doi: 10.1371/journal.pone.0125342. PubMed DOI PMC

Sipilä P.N., Lindbohm J.V., Batty G.D., Heikkilä N., Vahtera J., Suominen S., Väänänen A., Koskinen A., Nyberg S.T., Meri S., et al. Severe Infection and Risk of Cardiovascular Disease: A Multicohort Study. Circulation. 2023;147:1582–1593. doi: 10.1161/CIRCULATIONAHA.122.061183. PubMed DOI

Srivastava P., Nabeel P.M., Raj K.V., Soneja M., Chandran D.S., Joseph J., Wig N., Jaryal A.K., Thijssen D., Deepak K.K. Baroreflex Sensitivity Is Impaired in Survivors of Mild COVID-19 at 3–6 Months of Clinical Recovery; Association with Carotid Artery Stiffness. Physiol. Rep. 2023;11:e15845. doi: 10.14814/phy2.15845. PubMed DOI PMC

Szeghy R.E., Province V.M., Stute N.L., Augenreich M.A., Koontz L.K., Stickford J.L., Stickford A.S.L., Ratchford S.M. Carotid Stiffness, Intima–Media Thickness and Aortic Augmentation Index among Adults with SARS-CoV-2. Exp. Physiol. 2022;107:694–707. doi: 10.1113/EP089481. PubMed DOI PMC

Vriz O., Driussi C., La Carrubba S., Di Bello V., Zito C., Carerj S., Antonini-Canterin F. Comparison of Sequentially Measured Aloka Echo-Tracking One-Point Pulse Wave Velocity with SphygmoCor Carotid-Femoral Pulse Wave Velocity. SAGE Open Med. 2013;1:2050312113507563. doi: 10.1177/2050312113507563. PubMed DOI PMC

Wilkinson I.B., Franklin S.S., Hall I.R., Tyrrell S., Cockcroft J.R. Pressure Amplification Explains Why Pulse Pressure Is Unrelated to Risk in Young Subjects. Hypertension. 2001;38:1461–1466. doi: 10.1161/hy1201.097723. PubMed DOI