Pseudo-hypertension in the elderly: still hazy, after all these years

Spence, J. David

doi:10.1038/sj.jhh.1000529

Cited by 25 publications

(16 citation statements)

References 3 publications

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“…19 Therefore, pseudohypertension was defined as a diastolic cuff pressure Ͼ100 mm Hg and with an intra-arterial pressure Ͻ90 mm Hg. 30 This entity was thought to occur as often as 4% to 7% in elderly individuals who presented with hypertension. 30 It was often considered to have a benign prognosis but was never tested for cardiovascular risk in a population study.…”

Section: Pseudohypertension In the Elderlymentioning

confidence: 99%

“…30 It was often considered to have a benign prognosis but was never tested for cardiovascular risk in a population study. 29,30 Although, described by Spence et al 31,32 as diastolic pseudohypertension in subjects suspected of having pseudohypertension, with DBP frequently increased by as high as 20 mm Hg above normal values, intra-arterial SBP measurements were consistently elevated (frequently as high as stage 2 or 3 hypertension). These observations regarding diastolic pseudohypertension have been largely confirmed.…”

Section: Pseudohypertension In the Elderlymentioning

confidence: 99%

“…29,30 To fully appreciate how this became a clinical entity, one must understand its historical context. This entity was defined by the simultaneous measurement of brachial cuff and direct intra-arterial measurement in the 1970s and 1980s at a time when hypertension was classified almost exclusively by elevation in DBP; SBP was considered significantly elevated only with values of Ն160 mm Hg.…”

Section: Pseudohypertension In the Elderlymentioning

confidence: 99%

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Unusual Hypertensive Phenotypes

Franklin

Wilkinson

McEniery³

2012

Hypertension

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A ccording to Webster, 1 the terms "spurious," "artifactual," or "pseudo" denote false or deceptive resemblance. These terms when used specifically to hypertension refer to something that does not correspond with reality-a false perception; implicit in this definition is normalcy or a benign prognosis. Before discussion of the pros and cons of spurious, artifactual, or pseudohypertension, one should dispose of faulty technique (systematic error, terminal digit preference, or observer bias) in measuring blood pressure (BP), including cuff-inflation hypertension and failure to use the proper size cuff in obese arms as causes of erroneously high BP values. In this review, we limit our focus to the use of the terms "spurious," "artifactual," or "pseudohypertension" in relation to 3 unusual hypertensive phenotypes: (1) spurious isolated systolic hypertension (ISH) in late teenagers to young adults, defined as systolic BP (SBP) Ն140 mm Hg and diastolic BP (DBP) Ͻ90 mm Hg; (2) artifactual or benign isolated diastolic hypertension (IDH) in young to early middle-aged adults defined as a SBP Ͻ140 mm Hg and DBP Ն90 mm Hg; and (3) pseudohypertension in the elderly, presenting rarely with noncompressible artery syndrome and, more commonly, an elevated diastolic brachial artery pressure assessed indirectly with a cuff and sphygmomanometer, in the context of a "normal" intra-arterial pressure assessed invasively.The purpose of this review is to present evidence for and against with regard to the validity of these 3 forms of unusual hypertensive phenotypes. ISH in Late Teenagers to Young AdultsAlthough ISH is usually associated with the elderly, ISH is also the majority hypertensive subtype in adolescents 2 and young adults. 3 The phenomenon of spurious systolic hypertension in young individuals was first described by O'Rourke et al 4 in 6 young males, aged 14 to 23 years. The investigators noted elevated brachial SBP (150 -176 mm Hg) but normal brachial DBP (55-85 mm Hg), and all of these young subjects were relatively tall for their age. Using pulse wave analysis with the SphygmoCor system, a technique for measuring radial arterial waveforms and deriving central (aortic) pressure, they found a sharper-than-usual systolic peak and a normal mean arterial pressure and concluded that this was spurious (or pseudo-) hypertension secondary to exaggerated amplification of a normal central BP.Mahmud and Feely 5 identified ISH in 11 of 174 consecutively studied medical students (equally divided by sex), whose brachial BP averaged 147/70 mm Hg. All 11 of the subjects with ISH were tall men, nonsmokers, and active in sports. Using the SphygmoCor system, the difference between central and brachial SBPs was 31 mm Hg in those with ISH versus only 20 mm Hg in those with normotension. Following O'Rourke et al, 4 they attributed this hypertension subtype to spurious systolic hypertension secondary to exaggerated pressure amplification in healthy, athletically active men with slow heart rates and highly elastic central arteries. Pickering,6 in ...

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Section: Pseudohypertension In the Elderlymentioning

confidence: 99%

Section: Pseudohypertension In the Elderlymentioning

confidence: 99%

Section: Pseudohypertension In the Elderlymentioning

confidence: 99%

See 1 more Smart Citation

Unusual Hypertensive Phenotypes

Franklin

Wilkinson

McEniery³

2012

Hypertension

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“…Approximately 4% of elderly patients have a very significant (Ϸ30 mm Hg) difference between their diastolic cuff pressure and intra-arterial pressure. [11][12][13] Such patients would, therefore, have much lower pressures than measured, when their pressures are treated, and would be expected to have worsening of ischemia in the salvageable penumbra.…”

mentioning

confidence: 99%

Treating Hypertension in Acute Ischemic Stroke

Spence

2009

Hypertension

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“…22,23 False high BP measurements (pseudohypertension) can also be observed in patients with sclerotic, calcified arteries or other vascular lesions associated with aging. 24 The Osler maneuver (the presence of radial artery pulse after cuff inflation above SBP) should be performed if pseudohypertension is suspected; however, it has low sensitivity and specificity. 25 Lastly, when considering resistant hypertension, one should first exclude the reasons that may explain the persistence of increased BP (incorrect technique in measuring BP, pseudohypertension, nonadherence, suboptimal therapy) and then consider potential secondary hypertension causes (hyperaldosteronism, Cushing syndrome or other endocrine disorders, chronic kidney disease, use of drugs, such as nonsteroidal anti-inflammatory drugs, or alcohol, pheochromocytoma, and others).…”

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confidence: 99%

Current challenges in antihypertensive treatment in the elderly

Imprialos¹,

Boutari²,

Stavropoulos³

et al. 2016

Polish Archives of Internal Medicine

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is attributed to the gradual increase in SBP that comes with aging, whereas DBP tends to decline after 60 years of age, and thus the majority of elderly hypertensive patients have increased pulse pressure and isolated systolic hypertension. 4,5 Many aspects of hypertension treatment are similar in younger and older patients. However, given the unique features of hypertension in the elderly, several challenges arise that physicians have to deal with in daily clinical practice. 6 Target BP and optimal hypertensive treatment seem to be different between young and old patients. Trials in the elderly population using BP-reducing treatment seem to have provided a safe BP threshold of less than 150 mmHg to reduce morbidity and mortality events in fit elderly patients; on the contrary, data are inconclusive for the optimal antihypertensive strategies in frail elderly patients and those residing in nursing homes. 7Introduction Hypertension is a public health problem that affects almost 1 billion adults worldwide, and this number is estimated to reach 1.5 billion by 2025. The global prevalence of hypertension is increasing with age; approximately half of the population aged between 60 and 69 years and more than 60% of those over the age of 70 years are hypertensive. 1 Data from the Framingham study 2 suggest that normotensive men and women at the age of 55 years have a 93% and 91% lifetime risk of developing hypertension, respectively. Increased blood pressure (BP) has been independently associated in all ages with increased incidence of cardiovascular (CV) events, such as stroke, coronary artery disease, myocardial infarction, sudden death, and heart failure. 3 In the elderly population, systolic BP (SBP) and pulse pressure were shown to be better predictors of CV outcomes than diastolic BP (DBP). This ABSTRACTArterial hypertension affects more than 25% of the global population, and its prevalence is increasing with age. Arterial stiffening occurs with aging and results in a pattern of increased systolic and decreased diastolic blood pressure (BP). In the elderly population, elevated BP has been related with increased cardiovascular risk. Trials on this population have shown great benefits for morbidity and mortality from reducing systolic BP (SBP) levels to less than 150 mmHg. Most guidelines for the management of elderly hypertensive patients agree on BP reduction to less than 150/90 mmHg. However, there is still uncertainty whether further BP reduction could provide beneficial results. The recently published SPRINT trial demonstrated that reducing SBP to between 120 and 125 mmHg in patients over the age of 75 years is related with increased survival and is expected to affect future recommendations. On the contrary, the limited data that are available for patients aged 80 years or older and frail nursing home patients create concerns for more aggressive BP strategies in these subgroups, and thus they should be treated more conservatively. Among the various antihypertensive classes of drugs, diuretics, calcium channe...

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Pseudo-hypertension in the elderly: still hazy, after all these years

Cited by 25 publications

References 3 publications

Unusual Hypertensive Phenotypes

Unusual Hypertensive Phenotypes

Treating Hypertension in Acute Ischemic Stroke

Current challenges in antihypertensive treatment in the elderly

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