Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be Treated

McEniery, Carmel M.; Franklin, Stanley S.; Cockcroft, John R.; Wilkinson, Ian B.

doi:10.1161/hypertensionaha.116.06547

Cited by 58 publications

(52 citation statements)

References 86 publications

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“…4–6,27,28 A study from the Netherlands demonstrated normal aortic PWV with higher pressure amplification in young adults with ISH (n=57; mean age 28 years), suggesting ISH in the young as a spurious form of hypertension. 27 In contrast, a population study from the United Kingdom illustrated higher aortic stiffness and cardiac output in young adults with ISH (n=109; mean age 20 years) compared to normotensive individuals.…”

Section: Discussionmentioning

confidence: 99%

“…26 We also assessed whether the associations between ISH and outcomes were attenuated after adjustment for mean arterial pressure and visceral fat, known potential contributors to cardiovascular risk in persons with ISH. 4–6 Next, analyses for heterogeneity of effect between ISH and outcomes by age (<50 or ≥50 years) or race (black or non-black individuals) were performed, with inclusion of additive interaction terms. Lastly, although the categorical BP groups are a clinically relevant classification, 18 this approach may be arbitrary.…”

Section: Methodsmentioning

confidence: 99%

“…1–3 Nevertheless, whether ISH in young and middle-aged adults represents “pseudo” or “spurious” hypertension is debated. 4–6 We have recently shown that in Americans under 50 years of age, ISH was associated with an increased risk of cardiovascular disease (CVD) mortality compared with optimal BP. 7 However, the pathophysiology of ISH in those under 50 years of age is incompletely elucidated.…”

Section: Introductionmentioning

confidence: 99%

“…7 However, the pathophysiology of ISH in those under 50 years of age is incompletely elucidated. 4–6 …”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic and Mechanical Properties of the Proximal Aorta in Young and Middle-Aged Adults With Isolated Systolic Hypertension

et al. 2017

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The aim of this study is to assess characteristic impedance (Zc) of the proximal aorta in young and middle-aged individuals with isolated systolic hypertension (ISH). Zc is an index of aortic stiffness relative to aortic size. In the Dallas Heart Study, 2,001 untreated participants 18 to 64 years of age (mean age 42.3years, 44% black race) were divided into the following groups based on office blood pressure (BP) measurements: 1) optimal BP (systolic BP [SBP]<120 and [DBP]<80 mmHg; n=837); 2) prehypertension (SBP 120–139 and/or DBP 80–89 mmHg; n=821); 3) ISH (SBP ≥140 and DBP <90 mmHg; n=121); 4) isolated diastolic hypertension (IDH: SBP<140 and DBP≥90 mmHg; n=44); and 5) systolic-diastolic hypertension (SDH: SBP≥140 and DBP≥90 mmHg; n=178). Zc, aortic arch pulse wave velocity (PWV), and minimum ascending aortic size were quantified using cardiovascular magnetic resonance. In multivariable-adjusted linear models, Zc was highest in the ISH group compared with the optimal BP, IDH, or SDH groups (103.2±4.0 vs. 68.3±2.1, 75.4±6.0, and 88.9±4.8 dyne*sec/cm5, respectively; all P<0.05). The Zc-ISH association did not differ by race. Aortic PWV was highest in the ISH group compared with the optimal BP, IDH, or SDH groups (6.3±0.3 vs. 4.3±0.1, 4.4±0.4 and 5.5±0.3 m/s, respectively; all P<0.05), whereas aortic size was similar across groups (all P > 0.2). Results were similar in a subgroup of 1,551 participants 18 to 49 years of age. In a multiracial population-based sample, we found evidence of a mismatch between proximal aortic stiffness and diameter in young and middle-aged adults with ISH.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…7 However, the pathophysiology of ISH in those under 50 years of age is incompletely elucidated. 4–6 …”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic and Mechanical Properties of the Proximal Aorta in Young and Middle-Aged Adults With Isolated Systolic Hypertension

et al. 2017

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“…However, there are also opposing voices, suggesting the need of ISH treatment, as it may be a risk factor for cardiovascular complications in the future [14]. Recent study revealed that patients with ISH may have higher risk for cardiovascular diseases and coronary heart disease mortality in long term follow-up compared with those with normal BP [15].…”

Section: Discussionmentioning

confidence: 99%

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

Janiec¹,

Stępień²,

Skorek³

et al. 2017

Arterial Hypertension

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Introduction. Interest in isolated systolic hypertension (ISH) in young people has increased in recent years. The applanation tonometry technique provides new diagnostic opportunities in this group of patients. The aim of the study was to evaluate the incidence of ISH among young adults and factors contributing to its occurrence. Material and methods. One hundred and two medical students aged 21 to 26 years were examined. The study was based on three peripheral blood pressure measurements and central blood pressure measurement. Information on health status and physical activity was collected using the author-developed questionnaire. Results. Based on the mean of peripheral blood pressure measurements, hypertension (HT) was detected in 23 students (22.55%): 18 had ISH, 4 -combined systolic/diastolic HT and 1 -isolated diastolic HT. Pulse wave analysis showed that all individuals with ISH had central blood pressure within the normal range -higher than those without HT, but lower than in the combined systolic/diastolic HT group (p < 0.001). Subjects with ISH were characterized by higher pulse pressure amplitude and lower augmentation index (AIx) compared to those with normal blood pressure. Subjects with ISH were taller, had a higher body mass index (BMI) and were more likely to have a positive family history of HT compared to normotensives. They also reported more frequent coffee consumption; and 22% of them used creatine supplements (vs. 0% in non-HT group). Conclusions. Measurement of central arterial blood pressure by applanation tonometry should be an integral part of the assessment of young patients with ISH. The study confirmed that ISH patients are characterized by higher growth, weight and physical activity. Further studies are needed to assess the clinical significance of ISH.

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Assessment of Prevalence, Awareness, and Characteristics of Isolated Systolic Hypertension Among Younger and Middle-Aged Adults in China

Mahajan

Fang

et al. 2020

JAMA Netw Open

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Key Points Question What are the characteristics of young and middle-aged adults with isolated systolic hypertension in China, and what is the prevalence and awareness of isolated systolic hypertension among this population? Findings In this cross-sectional study of young and middle-aged adults in China, isolated systolic hypertension was identified in 27% of participants with hypertension, 87% of whom had not received treatment; less than 7% of individuals with untreated isolated systolic hypertension were aware of having hypertension. Among individuals with isolated systolic hypertension, 16% had systolic blood pressure of 160 mm Hg or higher, but awareness rates remained low even in this group. Meaning In this study, a substantial proportion of young and middle-aged adults with hypertension had isolated systolic hypertension; there is an opportunity to improve awareness of isolated systolic hypertension among this population.

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Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be Treated

Cited by 58 publications

References 86 publications

Hemodynamic and Mechanical Properties of the Proximal Aorta in Young and Middle-Aged Adults With Isolated Systolic Hypertension

Hemodynamic and Mechanical Properties of the Proximal Aorta in Young and Middle-Aged Adults With Isolated Systolic Hypertension

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

Assessment of Prevalence, Awareness, and Characteristics of Isolated Systolic Hypertension Among Younger and Middle-Aged Adults in China

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