Evolution of isolated systolic hypertension with normal central blood pressure in adolescents—prospective study

Abstract

Background The clinical significance of isolated systolic hypertension with normal central blood pressure known as spurious hypertension (sHT) in adolescents and its evolution over time is not known. Methods The aim of this study was to analyze changes in office, ambulatory blood pressure (ABPM), central systolic blood pressure (cSBP), hemodynamic parameters, and target organ damage (TOD) over a 1-year follow-up in a group of non-obese children with sHT. Results Of 294 patients referred for primary hypertension, 138 patients (31 girls; 22%) had hypertension confirmed by ABPM. 48/138 (35%) patients (7 girls; 15%) were diagnosed with sHT (elevated office and ambulatory systolic BP, but normal cSBP); 43 of them (6 girls; 14%) were followed for 12 ± 3 months during non-pharmacological therapy. At baseline 7 (16%) patients had borderline values of cIMT or LVMi indicating mild TOD. After 12 months, 10/43 (3 girls; 23%) patients developed sustained HT (elevated office, ambulatory BP and cSBP), 11/43 (1 girl; 26%) maintained sHT, and 22/43 (2 girls; 51%) evolved to white coat hypertension or normotension. The cSBP values increased in 27 patients (4 girls; 63%), but the group average remained in the normal range. Prevalence of TOD did not change during observation. The multivariate regression analysis showed that the only predictor of cSBP change over time was a change in serum uric acid level. Conclusions In conclusion, after 1 year of non-pharmacological treatment, 23% of adolescents with sHT developed sustained hypertension, with the main predictor of cSBP change being the change in serum uric acid.

Isolated systolic hypertension is associated with increased left ventricular mass index and aortic stiffness in adolescents: a cardiac magnetic resonance study

“…The observations suggest that spurious hypertension may not be a benign condition, as was previously suggested [3,4,31]. The results of a recent prospective study, which showed that after 12 months, 23% of pediatric patients with sHTN developed sustained hypertension with elevated cSBP, also speak against the benign nature of sHTN [6].…”

“…Moreover, some adolescents and young adults with ISH present with normal central SBP (cSBP) and hence it was hypothesized that this form of ISH may not be associated with increased cardiovascular risk and was therefore called spurious hypertension (sHTN) [3]. The clinical impact and proper management of ISH and sHTN remain controversial, with several studies showing contradictory results [1,[4][5][6].…”

Disparities between determinants of impaired vascular structure and function in young people with primary hypertension: a systematic review

“…The evidence in CYP with primary hypertension, however, remains limited. A recent study observed a decrease in BP and cfPWV z score (but not absolute values of cfPWV) in children over a 12-month period of nonpharmacological therapy [63]. Similarly, a BPindependent regression of cIMT and of CWSA, was observed in pediatric studies [32].…”

An adolescent with isolated systolic hypertension – case report and diagnostic and therapeutic approach

“…Secondly, what is at least the short-term outcome of patients with spurious hypertension? The data by Obrycki et al suggest that some of these individuals progress towards true hypertension with elevated CBP [20]. Moreover, the same group recently revealed that even patients with normal central blood pressure may have left ventricular hypertrophy [21], questioning whether "spurious" ISH is actually a benign condition.…”