Systemic stiffness a determinant of blood pressure
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Systemic stiffness: a determinant of blood pressure?. Cuno Uiterwaal Julius Centre Rick Grobbee Julius Centre Ralph Sakkers Paediatric orthopedics Paul Helders Child Physical therapy Ruud Bank TNO/LUMC Raoul Engelbert Child Physical therapy. Background blood pressure.

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Systemic stiffness a determinant of blood pressure l.jpg

Systemic stiffness: a determinant of blood pressure?

Cuno Uiterwaal Julius Centre

Rick Grobbee Julius Centre

Ralph Sakkers Paediatric orthopedics

Paul Helders Child Physical therapy

Ruud Bank TNO/LUMC

Raoul Engelbert Child Physical therapy

Julius Center for Health Sciences and Primary Care


Background blood pressure l.jpg
Background blood pressure

  • early life origin of primary hypertension

  • blood pressure - arterial wall stiffness

  • arterial wall stiffness - atherosclerosis

  • arterial wall stiffness - clinical disease

  • blood pressure - connective tissue vascular wall

Julius Center for Health Sciences and Primary Care


Background l.jpg
Background

Blood pressure partly determined by

vessel wall connective tissue metabolism

  • only localized metabolism or systemic?

Julius Center for Health Sciences and Primary Care


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Background

Connective tissue: collagen, elastin,

crosslinks

  • many different forms

  • tissue specific composition/metabolism

  • some similarities in different tissues

Julius Center for Health Sciences and Primary Care


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Childhood hypermobility syndromes

Part of diagnostic tools

  • Joint hypermobility

  • skin hyperextensibility

Julius Center for Health Sciences and Primary Care


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Background

joint mobility and cardiovascular disease

  • limited in diabetes mellitus (microangiopathy?)

  • limited in hypertensives??

  • very little research

    skin extensibility

  • no research

Julius Center for Health Sciences and Primary Care


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Research question: general

Is the relation between blood pressure and tissue stiffness confined to the ardiovascular system?

Julius Center for Health Sciences and Primary Care


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Research question: specific

Is blood pressure related to

joint mobility

skin extensibility

muscle strength

bone quality

in prepubertal children?

Julius Center for Health Sciences and Primary Care


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Childhood determinants of blood pressure

  • Age

  • gender

  • body height

  • body weight

  • family BP levels

Julius Center for Health Sciences and Primary Care


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Childhood determinants of joint mobility/skin extensibility

  • age

  • gender

  • body height

  • body weight

  • family levels

  • race

Julius Center for Health Sciences and Primary Care


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Study design: subjects

  • Cross-section of 95 Caucasian children

  • two primary school in Zeist (NL)

  • examined: November 2000

Julius Center for Health Sciences and Primary Care


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Study design: measurements

  • anthropometry

  • blood pressure (OMRON)

  • joint mobility: goniometry

  • skin extensibility: standard vacuum pressure

  • muscle strength: score

  • bone quality: ultrasound os calcis

  • questionnaires

Julius Center for Health Sciences and Primary Care



Median range joint motion left l.jpg
Median (range) joint motion left

Julius Center for Health Sciences and Primary Care


Median range skin extensibility left l.jpg
Median (range) skin extensibility left

Julius Center for Health Sciences and Primary Care





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Discussion

  • underpowered study

  • selection/information bias?

  • reverse causality?

  • unknown or residual confounding?

Julius Center for Health Sciences and Primary Care


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Conclusions

  • Part of the relation between blood pressure and tissue stiffness may be systemic

Julius Center for Health Sciences and Primary Care


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