The relationship between blood pressure variability, left ventricular hypertrophy, and arterial stiffness in children and adolescents with obesity.

BACKGROUND

Obesity and hypertension are major risk factors for cardiovascular target organ damage in childhood, including increased left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH). Blood pressure variability (BPV) has been suggested as a potential contributor to cardiovascular damage; however, its role in pediatric obesity remains unclear. This study was aimed at evaluating short-term BPV and pulse wave analysis (PWA) parameters in children and adolescents with obesity and their associations with LVMI and LVH.

METHODS

This retrospective cross-sectional study included 42 children and adolescents with obesity evaluated between October 2023 and August 2025, and 42 age- and sex-matched healthy children and adolescents (8-18 years). All participants underwent 24-h ambulatory blood pressure monitoring with simultaneous PWA and echocardiographic assessment of LVMI. Short-term BPV was assessed using standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). LVH was defined as LVMI above the 95th percentile for age and height. Correlation analyses and multivariable logistic regression analysis were performed.

RESULTS

Participants with obesity had higher ambulatory blood pressure levels, BPV indices, pulse wave velocity and central blood pressure values than healthy controls (p < 0.05). LVH prevalence was higher in the obese group (40% vs. 9%; OR = 6.29, 95% CI: 1.90-20.9). Short-term BPV parameters were not independently associated with LVH and showed no significant correlations with LVMI or the LVMI ratio.

CONCLUSIONS

Despite increased BPV and arterial stiffness in children and adolescents with obesity, short-term BPV was not independently associated with LVMI or LVH. Further prospective studies are warranted to clarify the clinical relevance of BPV in pediatric obesity.