title: Temporal trends in pulse pressure and mean arterial pressure during the rise of pediatric obesity in US children.
abstract: BACKGROUND
  Somatic growth in childhood is accompanied by substantial remodeling of the aorta. Obesity is associated with increased aortic stiffness and flow and may interfere with aortic remodeling during growth. Wide pulse pressure (PP) indicates mismatch between aortic impedance and pulsatile flow and increases risk for future systolic hypertension and cardiovascular disease (CVD). We hypothesized that the rise of pediatric obesity would be associated with a temporal trend to higher PP.
  
  
  RESULTS
  We analyzed demographic, anthropometric, and blood pressure (BP) data for 8- to 17-year-old children (N=16 457) from the cross-sectional National Health and Nutrition Examination Surveys (NHANES) for 1976 through 2008. Multivariable adjusted survey regression was used to examine temporal trends in PP and mean arterial pressure (MAP) and the relation to obesity. Across this period, unadjusted PP was higher (0.29 mm Hg/y, 95% CI 0.26 to 0.33 mm Hg/y; P<0.0001), while MAP was lower (-0.24 mm Hg/y, 95% CI -0.27 to -0.20 mm Hg/y; P<0.0001) across examinations. Adjusting for body mass index partially attenuated the temporal trend for PP by 32% (P<0.0001). Obesity amplified the relation between taller height and higher PP (from 0.23 [95% CI 0.19 to 0.28] to 0.27 [95% CI 0.21 to 0.34] mm Hg/cm height in boys and from 0.08 [95% CI 0.04 to 0.13] to 0.22 [95% CI 0.13 to 0.31] mm Hg/cm height in girls; P<0.01 for both).
  
  
  CONCLUSIONS
  PP has increased during the rise of pediatric obesity. Higher PP may indicate mismatch between aortic diameter, wall stiffness, and flow in obese children during a period of rapid somatic growth when the aorta is already under considerable remodeling stress.
authors.affiliation: Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Zachariah
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.forename: Sarah D
authors.initials: SD
authors.lastname: de Ferranti
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.forename: Gary F
authors.initials: GF
authors.lastname: Mitchell
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology*; D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology / Q000503:physiopathology*; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D066253:Vascular Remodeling / Q000502:physiology
keywords: NHANES; blood pressure; child; pulse pressure