Early Carotid Structural and Functional Changes Associated With Elevated Blood Pressure in Children: A Multimodal Ultrasound Study

Childhood hypertension is closely associated with cardiovascular disease in adulthood, and the carotid artery is one of the principal target organs affected by elevated blood pressure (BP). The purpose of this study is to assess the association between carotid ultrasound-derived indices and elevated BP in children and to identify early vascular changes using multimodal ultrasound imaging. This case-control observational study included 118 children aged 10-11 years, of whom 55 had elevated BP and 63 had normal BP. Carotid ultrasound measurements included carotid diameter, conventional carotid intima-media thickness (CIMT), ultrahigh frequency CIMT (uhf-CIMT), carotid intima thickness, carotid media thickness (CMT), intima-to-media ratio (I/M), and radiofrequency-derived pulse wave velocity (rf-PWV). Associations between ultrasound parameters and BP were evaluated using multivariate linear regression models adjusted for age, sex, and body mass index. Children with elevated BP had higher values of uhf-CIMT, CMT, rf-PWV and lower values of I/M compared with children with normal BP (all p < 0.05). Systolic BP with the strongest association observed for CMT (r = 0.45). After adjustment for potential confounders, elevated BP remained independently associated with CMT, uhf-CIMT, I/M, and rf-PWV (all p < 0.05). Rf-PWV was significantly associated with carotid structural indices, particularly the I/M ratio (p < 0.05). Elevated BP in children is associated with early carotid structural remodeling and increased arterial stiffness. Ultrahigh frequency ultrasound may facilitate the detection of subtle vascular changes in pediatric with elevated BP.