In contrast to isolated systolic hypertension (ISH) in old age, systolic blood pressure increase in boys is caused by a strong so-called amplification (benign increase) of the pressure wave from the thoracic aorta to the measurement point in the arm artery. Using pulse wave analysis with arteriograph, amplification values of up to 60 mmHg can be measured. Large, slim, athletic adolescents and young men are particularly affected. The increased amplification is an expression of particular vascular elasticity and/or increased heart beat volume (ejection capacity of the heart) with low or normal blood pressure in the thoracic aorta. The prognosis is accordingly good and a blood pressure-lowering therapy is not necessary according to the guidelines.
20- year old man: 188cm, BMI 22kg/m2
146/61 mmHg
Brachial blood pressure:
Central aortic blood pressure:
118 mmHg
6,5 m/s
Pulse wave velocity:
Original image of the pulse wave from the Arteriograph software
Atheroscleorsis
In contrast to isolated systolic hypertension (ISH) in old age, systolic blood pressure increase in boys is caused by a strong so-called amplification (benign increase) of the pressure wave from the thoracic aorta to the measurement point in the arm artery. Using pulse wave analysis with arteriograph, amplification values of up to 60 mmHg can be measured. Large, slim, athletic adolescents and young men are particularly affected. The increased amplification is an expression of particular vascular elasticity and/or increased heart beat volume (ejection capacity of the heart) with low or normal blood pressure in the thoracic aorta. The prognosis is accordingly good and a blood pressure-lowering therapy is not necessary according to the guidelines.
However, the results of the examination performed with the arteriograph show an increased central systolic blood pressure (SBPao), an increased pulse pressure of the aorta (PPao), an increased central augmentation index (AIXao), a reduced diastolic reflectance range (DRA) and a reduced diastolic range index (DAI) (see Figure 5).
The pulse wave velocity of the aorta is increased to 12 m/s (see Figure 6). The patient's PWVao is beyond the 95th percentile, indicating early vascular aging (EVA = Early Vascular Aging).
Considering that the high pulse wave velocity is a sign of vascular aging and our scientific findings show that at a sensitivity of 76%, an aortal pulse wave velocity above 9 m/s leads to asymptomatic carotid atherosclerosis (plaques), a carotid ultrasound examination was performed (see Figure 4).
The carotid ultrasound showed atherosclerotic plaques. Since atherosclerosis is a systemic disease of the middle and large arteries, we can assume that the coronary arteries can also be affected by arteriosclerosis.
Therefore, it was suggested to the patient to perform a computed tomography of the coronary arteries. The heart CT showed several plaques of the coronary arteries (see markings in figure).