Guidelines on guidelines

Abstract

Current guidelines on isolated systolic hypertension (ISH) suggest the same treatment to patients of all ages. Application of these guidelines in youth with ISH may not be appropriate, as presently no data show adverse outcome or benefit of drug therapy in this group. Simple noninvasive tonometric techniques now enable physicians to measure the central aortic pressure waveform and amplification of the pressure pulse. ISH in youth is usually caused by high amplification of the central pressure wave, whereas ISH in the elderly (>age 60) is attributable to aortic stiffening. This is the only group with ISH shown to have an adverse prognosis and to warrant drug therapy.

Isolated systolic hypertension — evaluation of the scale of the problem among medical students — pilot study

“…Assessment of cBP parameters can prevent patients from misdiagnosis and classification into a group requiring antihypertensive treatment. ISH subjects with normal cBP require only regular monitoring and lifestyle modification [17].…”

Pulsatile and Steady-State Pressure Trends in Children: Is the Future Now?

“…In a previous study [10], we have proposed that this can be a normal phenomenon in normal adolescents (especially in tall young males) due to high amplification of the pulse in the upper limb, warranting a description of ‘spurious systolic hypertension of youth'. We have pressed this view with respect to isolated systolic hypertension, urging that adolescents with high SP should have the central aortic pressure measured before being branded with the stigma of ‘hypertension' and being subject to investigations, therapy, and restrictions in a future career [11]. The European Societies of Hypertension and of Cardiology (ESH and ESC [12]) give credence to this view.…”

“…Isolated systolic hypertension was introduced in 1991 and became the major focus of attention in the treatment of hypertension. We believe that a mistake was made in applying the results of SHEP to persons under the age of 60 years, in many of whom elevated brachial SP was caused not by aortic stiffening [24], but by high amplification of brachial and radial pressure from a normal aortic pressure wave [10,11,25]. …”

“…The logic of Zachariah and Kovacikova [1] on measuring MP and PP is unfortunately flawed [10,11,24]. MP of an invasively recorded pressure wave is usually obtained by mathematical integration over the duration of the wave.…”

Vasculopathy of Aging and the Revised Cardiovascular Continuum

“…The European guidelines for hypertension in 2013 [19] pointed out that young people are being diagnosed as hypertensive only based on their elevated systolic pressure, even if they are otherwise perfectly healthy. The European guidelines suggested that central blood pressure be measured for the possibility of excessively amplified brachial blood pressure due to the narrow highly ‘spiked' pulse wave.…”