Unusual Hypertensive Phenotypes

Abstract

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 ...

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

“…26 in addition to the cBp values, the high variability of the amplification phenomenon between aortic and brachial sBp at all ages 7 leads to a more difficult interpretation.…”

“…26 Además de los valores de la PAc, la alta variabilidad del fenómeno de amplificación entre la PAS aórtica y la braquial, a todas las edades, 7 dificulta aún más la interpretación.…”

Effects of Prehypertension and Hypertension Subtype on Cardiovascular Disease in the Asia-Pacific Region

“…[16][17][18][19][20][21] In contrast, there has been uncertainty surrounding the effects of IDH on the risks of CVD. [16][17][18][19][20][21][22][23] As a result, patients with IDH, which constitutes 14% to 24% of the total hypertensive population, 18,20,24 are less likely to receive clinical attention and BP-lowering treatment than those with ISH or SDH. [18][19][20] The Asia Pacific Cohort Studies Collaboration (APCSC) is an individual participant data overview of cohort studies in the region.…”

Response to Pseudohypertension

“…Indeed, no new cases of pseudohypertension have been reported in the past 2 decades; in fact, as we concluded in our brief review 6 : it is time to provide a proper burial for this entity!…”