The Relationship Between Arterial Stiffness, Hand Grip Strength, Sedentary Behavior, and Physical Activity in Adolescents with Primary Hypertension

Year 2025, Volume: 3 Issue: 3, 100 - 108, 10.09.2025

Emine Burcu Özcan , Naciye Vardar Yağlı , Sevcan Bakkaloğlu , Bahar Büyükkaragöz , Aslı Kavaz Tufan , Yeşim Özdemir Atikel , Şule Pektaş Leblebicier , Emre Leventoğlu , Bahruz Hüseyinli , Merve Başol Göksuluk , Melda Sağlam

Abstract

Purpose: This study was aim to investigate the associations between pulse wave velocity (PWV) and hand grip strength, as well as the relationships between weekday and weekend sitting time and physical activity levels on adolescent patients with primary hypertension.
Methods: The study included 35 stable outpatients aged 10-19 years with primary hypertension. Demographic characteristics, physical and clinical conditions (diagnosis duration, birth weight, number of medications, etc.) were recorded. Anthropometric measurements was taken. Hand grip strength assessed using a hand dynamometer, arterial stiffness measurement using a Holter-Ambulatory Blood Pressure Monitor (ABPM). Physical activity barriers were assessed using the Physical Activity Barriers Scale, and physical activity level with the Child Physical Activity Questionnaire (PAQ-C). Physical inactivity and inactivity levels were recorded verbally.
Results: No significant relationship was found between dominant hand grip strength percentage and PWV values. A weak to moderate positive correlation was observed between dominant hand grip strength and PWV (r=0.423, p=0.022). A weak to moderate positive correlation was found between PWV and physical activity levels, and average weekly sitting and screen time (r=0.375, p=0.045, r=0.397, p=0.033, respectively). No significant relationship was found between PWV values and the Physical Activity Barriers Scale (p>0.05).
Conclusion: There is a moderate to weak relationship between handgrip strength, physical inactivity and sedentary behavior and PWV. There is no significant relationship between physical activity barriers and PWV. Future interventions should prioritize strategies to increase physical activity and reduce sedentary behavior to improve arterial health and overall cardiovascular outcomes in adolescents with hypertension.

Keywords

Primary Hypertension , Adolescence , Physical Activity , Sedantary Behaviour , Physical Activity Barriers

References

• 1. Zhou B, Perel P, Mensah GA, Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol. 2021;18(11):785-802.
• 2. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223-49.
• 3. Falkner B, Gidding SS, Baker-Smith CM, Brady TM, Flynn JT, Malle LM, et al. Pediatric Primary Hypertension: An Underrecognized Condition: A Scientific Statement From the American Heart Association. Hypertension. 2023;80(6):e101-e11.
• 4. Robinson CH, Chanchlani R. High Blood Pressure in Children and Adolescents: Current Perspectives and Strategies to Improve Future Kidney and Cardiovascular Health. Kidney Int Rep. 2022;7(5):954-70.
• 5. Yang L, Magnussen CG, Yang L, Bovet P, Xi B. Elevated Blood Pressure in Childhood or Adolescence and Cardiovascular Outcomes in Adulthood: A Systematic Review. Hypertension. 2020;75(4):948-55.
• 6. Kresnajati S, Lin YY, Mündel T, Bernard JR, Lin HF, Liao YH. Changes in Arterial Stiffness in Response to Various Types of Exercise Modalities: A Narrative Review on Physiological and Endothelial Senescence Perspectives. Cells. 2022;11(22).
• 7. Tsai JP, Hsu BG. Arterial stiffness: A brief review. Tzu Chi Med J. 2021;33(2):115-21.
• 8. Humphrey JD. Mechanisms of Vascular Remodeling in Hypertension. Am J Hypertens. 2021;34(5):432-41.
• 9. Agbaje AO. Arterial stiffness precedes hypertension and metabolic risks in youth: a review. J Hypertens. 2022;40(10):1887-96.
• 10. Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, et al. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension. 2015;66(3):698-722.
• 11. Ortega F, Silventoinen K, Tynelius P, Rasmussen F. Muscular strength in male adolescents and premature death: Cohort study of one million participants. BMJ (Clinical research ed). 2012;345:e7279.
• 12. Cohen DD, Gómez-Arbeláez D, Camacho PA, Pinzon S, Hormiga C, Trejos-Suarez J, et al. Low muscle strength is associated with metabolic risk factors in Colombian children: the ACFIES study. PLoS One. 2014;9(4):e93150.
• 13. Bim MA, Pinto AA, Scarabelot KS, Claumann GS, Pelegrini A. Handgrip strength and associated factors among Brazilian adolescents: A cross-sectional study. J Bodyw Mov Ther. 2021;28:75-81.
• 14. Thivel D, Tremblay A, Genin PM, Panahi S, Rivière D, Duclos M. Physical Activity, Inactivity, and Sedentary Behaviors: Definitions and Implications in Occupational Health. Front Public Health. 2018;6:288.
• 15. Christofaro DG, De Andrade SM, Cardoso JR, Mesas AE, Codogno JS, Fernandes RA. High blood pressure and sedentary behavior in adolescents are associated even after controlling for confounding factors. Blood Press. 2015;24(5):317-23.
• 16. Klepac Pogrmilovic B, Ramirez Varela A, Pratt M, Milton K, Bauman A, Biddle SJH, et al. National physical activity and sedentary behaviour policies in 76 countries: availability, comprehensiveness, implementation, and effectiveness. Int J Behav Nutr Phys Act. 2020;17(1):116.
• 17. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. 2020;54(24):1451-62.
• 18. van Sluijs EMF, Ekelund U, Crochemore-Silva I, Guthold R, Ha A, Lubans D, et al. Physical activity behaviours in adolescence: current evidence and opportunities for intervention. Lancet. 2021;398(10298):429-42.
• 19. Chen J, Wang Y, Li W, Zhang Y, Cao R, Peng X, et al. Physical activity and eating behaviors patterns associated with high blood pressure among Chinese children and adolescents. BMC Public Health. 2023;23(1):1516.
• 20. Köchli S, Endes K, Steiner R, Engler L, Infanger D, Schmidt-Trucksäss A, et al. Obesity, High Blood Pressure, and Physical Activity Determine Vascular Phenotype in Young Children. Hypertension. 2019;73(1):153-61.
• 21. Benas D, Kornelakis M, Triantafyllidi H, Kostelli G, Pavlidis G, Varoudi M, et al. Pulse wave analysis using the Mobil-O-Graph, Arteriograph and Complior device: a comparative study. Blood Press. 2019;28(2):107-13.
• 22. Erdim L, Ergün A, Kuğuoğlu S. Reliability and validity of the Turkish version of the Physical Activity Questionnaire for Older Children (PAQ-C). Turk J Med Sci. 2019;49(1):162-9.
• 23. Steenson S, Özcebe H, Arslan U, Konşuk Ünlü H, Araz Ö M, Yardim M, et al. Assessing the validity and reliability of family factors on physical activity: A case study in Turkey. PLoS One. 2018;13(6):e0197920.
• 24. Ramírez-Vélez R, Tordecilla-Sanders A, Correa-Bautista JE, Peterson MD, Garcia-Hermoso A. Handgrip strength and ideal cardiovascular health among Colombian children and adolescents. The Journal of pediatrics. 2016;179:82-9. e1.
• 25. Rodrigues de Lima T, Custódio Martins P, Henrique Guerra P, Augusto Santos Silva D. Muscular Fitness and Cardiovascular Risk Factors in Children and Adolescents: A Systematic Review. The Journal of Strength & Conditioning Research. 2020;34(8):2394-406.
• 26. Veijalainen A, Tompuri T, m Haapala EA, Viitasalo A, Lintu N, Väistö J, et al. Associations of cardiorespiratory fitness, physical activity, and adiposity with arterial stiffness in children. Scand J Med Sci Sports. 2016;26(8):943-50.
• 27. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318-27.
• 28. Yamanashi H, Kulkarni B, Edwards T, Kinra S, Koyamatsu J, Nagayoshi M, et al. Association between atherosclerosis and handgrip strength in non-hypertensive populations in India and Japan. Geriatr Gerontol Int. 2018;18(7):1071-8.
• 29. Kim W, Kim SH, Choi CU, Lee SK, Kang DO, Choi JY, et al. Role of arterial stiffness in the association between hand grip strength and cardiovascular events: the Korean Genome and Epidemiology Study. J Hypertens. 2021;39(6):1203-9.
• 30. Zhang Y, Miyai N, Abe K, Utsumi M, Uematsu Y, Terada K, et al. Muscle mass reduction, low muscle strength, and their combination are associated with arterial stiffness in community-dwelling elderly population: the Wakayama Study. J Hum Hypertens. 2021;35(5):446-54.
• 31. Ding C, Fan J, Yuan F, Feng G, Gong W, Song C, et al. Association between Physical Activity, Sedentary Behaviors, Sleep, Diet, and Adiposity among Children and Adolescents in China. Obes Facts. 2022;15(1):26-35.
• 32. Nagata JM, Vittinghoff E, Pettee Gabriel K, Garber AK, Moran AE, Sidney S, et al. Physical Activity and Hypertension From Young Adulthood to Middle Age. Am J Prev Med. 2021;60(6):757-65.
• 33. Marshall ZA, Mackintosh KA, McNarry MA. Investigating the influence of physical activity composition on arterial stiffness in youth. Eur J Sport Sci. 2023;23(4):617-24.
• 34. Edwards NM, Daniels SR, Claytor RP, Khoury PR, Dolan LM, Kimball TR, et al. Physical activity is independently associated with multiple measures of arterial stiffness in adolescents and young adults. Metabolism. 2012;61(6):869-72.
• 35. Hamrahian SM, Falkner B. Approach to Hypertension in Adolescents and Young Adults. Curr Cardiol Rep. 2022;24(2):131-40.
• 36. Vojtisek N. Barriers to Physical Activity in Adolescents. The Colledge at. 2019.
• 37. Alhroub N, Al-Sarairhe I, Awamleh RA, Ayasreh I, Alkhawaldeh A, M AL, et al. Physical Activity Barriers Among Adolescents in Jordan: A Cross-Sectional Study. SAGE Open Nurs. 2024;10:23779608241272688.
• 38. Zelenovic M, ManİĆ M, Stamenković A, Čaprić I, Božić D. Barriers to physical activity in adolescents: A systematic review. Turkish Journal of Kinesiology. 2021;7:22-30.