Pulse wave reflection in children: amplification through the lifecourse

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In this issue, Murakami et al.[1] detail the presence of wave reflection in the aortic system of healthy children. Identifying the components of early-life blood pressure (BP) is of critical importance as evidence builds on the role of BP in predicting future atherosclerotic cardiovascular disease (ASCVD). Classic literature has demonstrated the ability for historical BP to predict presence of atherosclerotic plaque in younger persons victim to unfortunate mortality like accident and war [2–5]. Recent data show a continuous relation between adolescent male BP separated into various indices including SBP, DBP, pulse pressure (PP), mean arterial pressure (MAP), and eventual adult ASCVD events [6]. Similar data from Native American populations show physician diagnosed hypertension in childhood as a risk factor for early mortality [7]. One study of adolescent men suggests that adolescent BP predicts future ASCVD even after adjustment for middle-aged BP, underscoring the additive utility of early-life BP [8]. Mounting evidence further demonstrates the specific role of elevated BP in preclinical atherosclerotic changes including left ventricular hypertrophy and vascular change [9,10]. Intriguing longitudinal data even suggest that normalization of elevated BP from childhood into adulthood ameliorates these preclinical atherosclerotic changes [11]. There are now multiple threads of evidence linking early-life BP to preclinical in-vivo atherosclerosis, pathological evidence of atherosclerotic plaque, actual ASCVD events and mortality, and even reversal of atherosclerotic change with attenuation in BP.

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