Arterial stiffness indirectly raises BP in adolescence via insulin resistance pathway

Globally efforts are being put for screening, identification, and early diagnosis of hypertension for prevention of its sequelae from early life.Researchers have recently shown that arterial stiffness, which has been established as a causal risk factor for hypertension in adults, is also implicated in the young population.

According to a new study, Arterial stiffness raises blood pressure in adolescents via insulin resistance.

In the new study, researchers examined whether arterial stiffness raises blood pressure via increased body fat or insulin resistance in a largely normal-weight adolescent population. This is because clinical trials in the young population have shown that lifestyle intervention could lower body fat and insulin resistance. Therefore, should arterial stiffness indirectly raise blood pressure through any of these pathways, it could be clinically relevant to intercept that path.

It is well known that obesity increases the risk of hypertension. Researchers have recently shown that arterial stiffness, which has been established as a causal risk factor for hypertension in adults, is also implicated in the young population.

Arterial stiffness may also cause increased insulin resistance in adolescents and young adults. Unfortunately, clinical trials to lower arterial stiffness in adults have not been promising, and clinical trials in the young population are ongoing.

"We found that arterial stiffness indirectly raised blood pressure in adolescence via the insulin resistance pathway. It is nonetheless surprising that increased body fat was not a pathway through which arterial stiffness raised blood pressure in this general population of adolescents. Until results from clinical trials on reducing arterial stiffness in adolescents are available, it may be important for pediatricians and public health experts to focus on encouraging healthy lifestyle choices that lower insulin resistance thereby potentially lowering blood pressure.

Increasing physical activity, reducing screen time, quitting smoking or vaping, reducing salt and sugar intake, increasing vegetable and fibre portion of diet, and having optimal daily sleep are healthy lifestyle choices," says Andrew Agbaje, a physician and clinical epidemiologist at the University of Eastern Finland.

References:

1. Agbaje AO, Barker AR, Tuomainen T-P. Effects of arterial stiffness and carotid intima- media thickness progression on the risk of overweight/obesity and elevated blood pressure/ hypertension: a cross-lagged cohort study. Hypertension. (2022) 79:159–69. doi: 10.1161/HYPERTENSIONAHA.121.18449

2. Song P, Zhang Y, Yu J, Zha M, Zhu Y, Rahimi K, et al. Global prevalence of hypertension in children: a systematic review and meta-analysis. JAMA Pediatr. (2019) 173:1154–63. doi: 10.1001/jamapediatrics.2019.3310

3. Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. (2016) 34:1887–920. doi: 10.1097/HJH.0000000000001039

4. Hall ME, Cohen JB, Ard JD, Egan BM, Hall JE, Lavie CJ, et al. Weight-loss strategies for prevention and treatment of hypertension: a scientific statement from the American heart association. Hypertension. (2021) 78:e38–50. doi: 10.1161/HYP.0000000000000202