Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지

Pulse wave velocity and ankle brachial index in normal adolescents

정상 청소년에서 맥파 속도와 발목 상완 동맥압 지수에 대한 연구

  • Kim, Ji Hye (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Gil, Tae Young (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Lee, Hee Woo (Seoul School Health Promotion Center) ;
  • Hong, Young Mi (Department of Pediatrics, School of Medicine, Ewha Womans University)
  • 김지혜 (이화여자대학교 동대문병원 소아과) ;
  • 길태영 (이화여자대학교 동대문병원 소아과) ;
  • 이희우 (서울특별시 학교보건진흥원) ;
  • 홍영미 (이화여자대학교 동대문병원 소아과)
  • Received : 2007.04.13
  • Accepted : 2007.05.02
  • Published : 2007.06.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Pulse wave velocity (PWV) and ankle brachial index (ABI) are simple, non-invasive methods to assess arterial stiffness. These parameters are also known to be closely related to cardiovascular risk factors and diseases. The purposes of this study were to measure blood pressure, PWV, ABI in healthy Korean adolescents, set up their normal values and assess their correlations. Methods : Three hundred ninety two healthy adolescents (213 boys and 179 girls) underwent measurement of brachial ankle pulse wave velocity (baPWV), ABI, body mass index(BMI) and blood pressure from four extremities. Linear regression analysis was performed to reveal the correlations between PWV, ABI and independent variables. Results : Blood pressure and PWV were significantly higher in all extremities in males compared to females. Blood pressure of both brachial and ankle showed positive correlation with body weight, height, and BMI, whereas ABI showed no correlation with any of these indices. Conclusion : Blood pressure increases as body weight, height and BMI increases. PWV shows positive correlation with blood pressure. It will be helpful to predict the risks of cardiovascular diseases in adolescents.

목 적 : 성인에서 맥파 속도와 발목 상완 동맥압 지수는 동맥 경직도를 측정할 수 있는 비침습적 방법이며 혈압, 고지혈증 등의 심혈관계 위험 인자와 연관성이 있어 심혈관계 질환과 관련이 있음이 알려져 있다. 본 연구는 우리나라 청소년에서 신장, 체중, 체질량 지수와 혈압, 맥파 속도, 발목 상완 동맥압 지수를 측정하였고 이들 사이의 상관성을 알아보고 정상 기준값를 확립하고자 하였다. 방 법 : 서울 시내 3개 고등학교에 재학 중인 15-16세 사이의 청소년 392명(남자 213명, 여자 179명)을 대상으로 신장, 체중, 체질량지수, 좌우 상완 및 발목의 수축기, 이완기, 평균 혈압과 양측 맥파 속도, 발목 상완 동맥압 지수, 박출 시간, 전구출기를 VP-1000(Colin사, Komaki, Japan)을 이용하여 측정하였다. 결 과 : 사지의 수축기, 이완기 평균 혈압은 남자에서 여자보다 유의하게 높은 값을 보였다(P<0.05). 우측 상완-발목 맥파 속도는 남자에서 $1,015.4{\pm}130.0cm/sec$, 여자에서 $947.6{\pm}105.1cm/sec$로서 남자에서 유의하게 높은 값을 보였다. 좌측 상완 발목 맥파 속도도 마찬가지로 남자에서 $1,023.4{\pm}132.5cm/sec$, 여자에서 $954.6{\pm}102.4cm/sec$로 남자에서 유의하게(P<0.05) 높은 값을 보였다. 발목 상완 동맥압 지수는 남녀 간에 유의한 차이를 보이지 않았다. 우측 상완-발목 맥파 속도의 기준값는 남자에서 1,032.4 cm/sec, 여자에서 963.1 cm/sec이었고, 좌측 상완-발목 맥파 속도는 남자에서 1,041.3 cm/sec, 여자에서 969.7 cm/sec이었다. 우측 발목 상완 동맥압 지수의 기준값은 남자에서 1.06, 여자에서 1.06이었으며, 좌측 발목 상완 동맥압지수의 기준값은 남자에서 1.05, 여자에서 1.06이었다. 맥파 속도는 사지 모두에서 혈압이 높아질수록, 유의한 양의 상관관계를 보였다. 또한 신장이 커질수록, 체중이 증가할수록, 체질량지수가 커질수록 사지의 혈압이 증가하는 유의한 양의 상관관계를 보였다. 반면, 발목 상완 동맥압 지수는 남녀 사이에 유의한 차이가 없었으며, 체중, 신장, 체질량지수 어느 것과도 유의한 상관관계가 없었다. 결 론 : 혈압은 신장, 체중, 체질량지수에 따라 높아지며 맥파 속도와 혈압 사이에도 유의한 양의 상관관계가 있다. 정상 청소년에서 측정한 맥파 속도의 기준값을 바탕으로 심혈관계 질환의 위험도를 조기 발견하고 예측하는데 유용하게 사용할 수 있을 것으로 생각한다.

Keywords

References

  1. Elizinga G, Westerhof N. Pressure and flow generated by the left ventricle against different impedances. Circ Res 1973;32:178-86 https://doi.org/10.1161/01.RES.32.2.178
  2. Sunagawa K, Maughn WL, Sagawa K. Stroke volume effect of changing arterial input impedance over selected frequency ranges. Am J Physiol 1985;248:477-84
  3. Asmar R, Benetos A, Topuchian J, Laurent P, Pannier B, Brisac AM. et al. Assessment of arterial distensibility by automatic pulse wave velocity measurement. Hypertension 1995;26:485-90 https://doi.org/10.1161/01.HYP.26.3.485
  4. Lehmann ED, Hopkins KD, Rawesh A, Joseph RC, Kongola K, Coppack SW, et al. Relation between number of cardiovascular risk factors/events and noninvasive Doppler ultrasound assessments of aortic compliance. Hypertension 1998;32:565-9 https://doi.org/10.1161/01.HYP.32.3.565
  5. Dhillon R, Clarkson P, Donald AE, Powe AJ, Nash M, Novelli V, et al. Endothelial dysfunction late after Kawasaki Disease. Circulation 1996;94:2103-6 https://doi.org/10.1161/01.CIR.94.9.2103
  6. Yoshimura S, Sugai J, Hashimoto H, Okamura T, Yamagishi N, Hasegawa M, et al. An estimation of arteriosclerosis by the measurement of pulse wave velocity and an analysis of the clinical effect of therapeutic agents on arteriosclerosis. Cor Vasa 1968;10:173-82
  7. McGill HC Jr, McMahan CA, Herderick EE, Malcom GT, Tracy RE, Strong JP. Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr 2000;72(5 Suppl):1307S- 15S
  8. Matsui Y, Kario K, Ishikawa J, Eguchi K, Hoshide S, Shimada K. Reproducibility of arterial stiffness indices (Pulse wave velocity and augmentation index) simultaneously assessed by automated pulse wave analysis and their associated risk factors in essential hypertensive patients. Hypertens Res 2004;27:851-7 https://doi.org/10.1291/hypres.27.851
  9. O'Rourke MF, Staessen JA, Vlachopoulos C, Duprez D, Plante GE. Clinical applications of arterial stiffness; definitions and reference values. Am J Hypertens 2002;15:426-44 https://doi.org/10.1016/S0895-7061(01)02319-6
  10. Yamashima A, Tomiyama H, Takeda K, Tsuda H, Arai T, Hirose K, et al. Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res 2002;25:359-64 https://doi.org/10.1291/hypres.25.359
  11. Munakata M, Ito N, Nunokawa T, Yoshinaga K. Utility of automated brachial ankle pulse wave velocity measurements in hypertensive patients. Am J Hypertens 2003;16: 653-7 https://doi.org/10.1016/S0895-7061(03)00918-X
  12. Andoh N, Minami J, Ishimitsu T, Ohrui M, Matsuoka H. Relationship between markers of inflammation and brachialankle pulse wave velocity in Japanese men. Int Heart J 2006;47:409-20 https://doi.org/10.1536/ihj.47.409
  13. Avolio AP, Chen SG, Wang RP, Zhang CL, Li MF, O'Rourke MF. Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community. Circulation 1983;68:50-8 https://doi.org/10.1161/01.CIR.68.1.50
  14. Khoshdel AR, Thakkinstian A, Carney SL, Attia J. Estimation of an age-specific reference interval for pulse wave velocity: a meta-analysis. J Hypertens 2006;24:1231-7 https://doi.org/10.1097/01.hjh.0000234098.85497.31
  15. Simon AC, Levenson J, Bouthier J, Safar ME, Avolio AP. Evidence of early degenerative changes in large arteries in human essential hypertension. Hypertension 1985;7:675-80 https://doi.org/10.1161/01.HYP.7.5.675
  16. Taniwaki H, Kawagishi T, Emoto M, Shoji T, Kanda H, Maekawa K, et al. Correlation between the intima-media thickness of the carotid artery and aortic pulse-wave velocity in patients with type 2 diabetes. Vessel wall properties in type 2 diabetes. Diabetes Care 1999;22:1851-7 https://doi.org/10.2337/diacare.22.11.1851
  17. Niboshi A, Hamaoka K, Sakata K, Inoue F. Characteristics of brachial-ankle pulse wave velocity in Japanese children. Eur J Pediatr 2006;165;625-9 https://doi.org/10.1007/s00431-006-0135-y
  18. Amar J, Ruidavets JB, Chamontin B, Drouet L, Ferrieres J. Arterial stiffness and cardiovascular risk factors in a population- based study. J Hypertens 2001;19:381-7 https://doi.org/10.1097/00004872-200103000-00005
  19. Blacher J, Asmar R, Djane S, London GM, Safar ME.Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension 1999;33:1111-7 https://doi.org/10.1161/01.HYP.33.5.1111
  20. van Popele NM, Bos WJ, de Beer NA, van Der Kuip DA, Hofman A, Grobbee DE, et al. Arterial stiffness as underlying mechanism of disagreement between an oscillometric blood pressure monitor and a sphygmomanometer. Hypertension 2000;36:484-8 https://doi.org/10.1161/01.HYP.36.4.484
  21. London GM, Guerin AP, Pannier B, Marchais SJ, Stimpel M. Influence of sex on arterial hemodynamics and blood pressure. Role of body height. Hypertension 1995;26:514-9 https://doi.org/10.1161/01.HYP.26.3.514
  22. Sonesson B, Hansen F, Lanne T. Abnormal mechanical properties of the aorta in Marfan's syndrome. Eur J Vasc Surg 1994;8:595-601 https://doi.org/10.1016/S0950-821X(05)80597-3
  23. Sonesson B, Hansen F, Lanne T. The mechanical properties of elastic arteries in Ehlers-Danlos syndrome. Eur J Vasc Endovasc Surg 1997;14:258-64 https://doi.org/10.1016/S1078-5884(97)80237-7
  24. Lanne T, Sonesson B, Bergqvist D, Bengtsson H, Gustafsson D. Diameter and compliance in the male human abdominal aorta: influence of age and aortic aneurysm. Eur J Vasc Surg 1992;6:178-84 https://doi.org/10.1016/S0950-821X(05)80237-3
  25. Ong CM, Canter CE, Gutierrez FR, Sekarski DR, Goldring DR. Increased stiffness and persistent narrowing of the aorta after successful repair of coarctation of the aorta: relationship to left ventricular mass and blood pressure at rest and with exercise. Am Heart J 1992;123:1594-600 https://doi.org/10.1016/0002-8703(92)90815-D
  26. Iannuzzi A, Rubba P, Pauciullo P, Celentoano E, Capano G, Sartorio R, et al. Stiffness of the aortic wall in hypercholesterolemic children. Metabolism 1999;48:55-9 https://doi.org/10.1016/S0026-0495(99)90010-0
  27. Okubo M, Ino T, Takahashi K, Kishiro M, Akimoto K, Yamashiro Y. Age dependency of stiffness of the abdominal aorta and the mechanical properties of the aorta in Kawasaki disease in children. Pediatr Cardiol 2001;22: 198-203 https://doi.org/10.1007/s002460010203
  28. Koji Y, Tomiyama H, Ichihashi H, Nagae T, Tanaka N, Kenji T, et al. Comparison of ankle-brachial pressure index and pulse wave velocity as markers of the presence of coronary artery disease in subjects with a high risk of atherosclerotic cardiovascular disease. Am J Cardiol 2004; 94:868-72 https://doi.org/10.1016/j.amjcard.2004.06.020
  29. Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Eng J Med 1992;326:381-6 https://doi.org/10.1056/NEJM199202063260605
  30. McKenna M, Wolfson S, Kuller L. The ratio of ankle and arm arterial pressure as an independent predictor of mortality. Atherosclerosis 1991;87:119-28 https://doi.org/10.1016/0021-9150(91)90014-T
  31. Doobay AV, and SS. Sensitivity and specificity of the ankle-brachial index to predict future cardiovascular outcomes: a systematic review. Arterioscler Thromb Vasc Biol 2005;25:1463-9 https://doi.org/10.1161/01.ATV.0000168911.78624.b7