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Prevalence and clinical characteristics of isolated systolic hypertension in young: analysis of 24 h ambulatory blood pressure monitoring database

Journal of Human Hypertension volume 36, pages 40–50 (2022)Cite this article

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Abstract

Isolated systolic hypertension (ISHT) is common in elderly patients, whilst its prevalence and clinical impact in young adults are still debated. We aimed to estimate prevalence and clinical characteristics of ISHT and to evaluate out-of-office BP levels and their correlations with office BP in young adults. A single-center, cross-sectional study was conducted at our Hypertension Unit, by including treated and untreated individuals aged 18–50 years, who consecutively underwent home, clinic and 24 h ambulatory BP assessment. All BP measurements were performed and BP thresholds were set according to European guidelines: normotension (NT), clinic BP <140/<90 mmHg; ISHT, BP ≥140/<90 mmHg; isolated diastolic hypertension (IDHT), BP <140/≥90 mmHg; systolic–diastolic hypertension (SDHT), BP ≥140/≥90 mmHg. European SCORE, vascular and cardiac HMOD were also assessed. From an overall sample of 13,053 records, we selected 2127 young outpatients (44.2% female, age 40.5 ± 7.4 years, BMI 26.7 ± 5.0 kg/m2, clinic BP 141.1 ± 16.1/94.1 ± 11.8 mmHg, 24 h BP 129.0 ± 12.8/82.4 ± 9.8 mmHg), among whom 587 (27.6%) had NT, 391 (18.4%) IDHT, 144 (6.8%) ISHT, and 1005 (47.2%) SDHT. Patients with ISHT were predominantly male (61.1%), younger and with higher BMI compared to other groups. They also showed higher home and 24 h ambulatory SBP levels than those with NT or IDHT (P < 0.001), though similar to those with SDHT. ISHT patients showed significantly higher pulse pressure (PP) levels than other groups, at all BP measurements (P < 0.001 for all comparisons), and significantly higher proportion (65.3%) of patients with ISHT had PP >60 mmHg. European SCORE resulted significantly higher in patients with ISHT (1.6 ± 2.9%) and SDHT (1.5 ± 2.7%) compared to those with IDHT (0.9 ± 1.5%) or NT (0.8 ± 1.9%) (P = 0.017). Though relatively rare, ISHT should be not viewed as a benign condition, being associated with sustained SBP elevation, high European SCORE risk, and vascular HMOD.

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Fig. 1: Distribution of different hypertension phenotypes according to predefined age, gender and treatment groups.
Fig. 2: Distribution of different hypertension phenotypes in the overall sample and in different age, gender and treatment groups.

References

  1. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  Google Scholar 

  2. Franklin SS, Jacobs MJ, Wong ND, L’Italien GJ, Lapuerta P. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives: analysis based on National Health and Nutrition Examination Survey (NHANES) III. Hypertension. 2001;37:869–74.

    Article  CAS  Google Scholar 

  3. Wallace SM, Yasmin, McEniery CM, Mäki-Petäjä KM, Booth AD, Cockcroft JR, et al. Isolated systolic hypertension is characterized by increased aortic stiffness and endothelial dysfunction. Hypertension. 2007;50:228–33.

    Article  CAS  Google Scholar 

  4. Saladini F, Palatini P. Isolated systolic hypertension in young individuals: pathophysiological mechanisms, prognostic significance, and clinical implications. High Blood Press Cardiovasc Prev. 2017;24:133–9.

    Article  Google Scholar 

  5. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997;350:757–64.

    Article  CAS  Google Scholar 

  6. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA. 1991;265:3255–64.

  7. Curb JD, Pressel SL, Cutler JA, Savage PJ, Applegate WB, Black H, et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group. JAMA. 1996;276:1886–92.

    Article  CAS  Google Scholar 

  8. Radchenko GD, Torbas OO, Sirenko YM. Predictors of high central blood pressure in young with isolated systolic hypertension. Vasc Health Risk Manag. 2016;12:321–8.

    Article  CAS  Google Scholar 

  9. Palatini P, Saladini F, Mos L, Fania C, Mazzer A, Casiglia E. Clinical characteristics and risk of hypertension needing treatment in young patients with systolic hypertension identified with ambulatory monitoring. J Hypertens. 2018;36:1810–5.

    Article  CAS  Google Scholar 

  10. Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH, et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348:2407–15.

    Article  Google Scholar 

  11. Parati G, Omboni S, Palatini P, Rizzoni D, Bilo G, Valentini M, et al. Italian society of hypertension guidelines for conventional and automated blood pressure measurement in the office, at home and over 24 h. High Blood Press Cardiovasc Prev. 2008;15:283–310.

    Article  Google Scholar 

  12. Parati G, Stergiou G, O’Brien E, Asmar R, Beilin L, Bilo G, et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens. 2014;32:1359–66.

    Article  CAS  Google Scholar 

  13. Palatini P, Rosei EA, Avolio A, Bilo G, Casiglia E, Ghiadoni L, et al. Isolated systolic hypertension in the young: a position paper endorsed by the European Society of Hypertension. J Hypertens. 2018;36:1222–36.

    Article  CAS  Google Scholar 

  14. Figliuzzi I, Presta V, Miceli F, Citoni B, Coluccia R, Ceccarini G, et al. 24-Hour ambulatory blood pressure levels and control in a large cohort of adult outpatients with different classes of obesity. J Hum Hypertens. 2019;33:298–307.

    Article  CAS  Google Scholar 

  15. Tocci G, Presta V, Figliuzzi I, Attalla El Halabieh N, Battistoni A, Coluccia R, et al. Prevalence and clinical outcomes of white-coat and masked hypertension: analysis of a large ambulatory blood pressure database. J Clin Hypertens. 2018;20:297–305.

    Article  Google Scholar 

  16. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97.

    Article  Google Scholar 

  17. Ryden L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer MJ, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J. 2007;28:88–136.

    Article  CAS  Google Scholar 

  18. Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24:987–1003.

    Article  CAS  Google Scholar 

  19. O’Rourke MF, Vlachopoulos C, Graham RM. Spurious systolic hypertension in youth. Vasc Med. 2000;5:141–5.

    Article  Google Scholar 

  20. Mahmud A, Feely J. Spurious systolic hypertension of youth: fit young men with elastic arteries. Am J Hypertens. 2003;16:229–32.

    Article  Google Scholar 

  21. McEniery CM, Yasmin, Wallace S, Maki-Petaja K, McDonnell B, Sharman JE, et al. Increased stroke volume and aortic stiffness contribute to isolated systolic hypertension in young adults. Hypertension. 2005;46:221–6.

    Article  CAS  Google Scholar 

  22. McEniery CM, Franklin SS, Cockcroft JR, Wilkinson IB. Isolated systolic hypertension in young people is not spurious and should be treated: pro side of the argument. Hypertension. 2016;68:269–75.

    Article  CAS  Google Scholar 

  23. O’Rourke MF, Adji A. Guidelines on guidelines: focus on isolated systolic hypertension in youth. J Hypertens. 2013;31:649–54.

    Article  Google Scholar 

  24. McEniery CM, Franklin SS, Wilkinson IB, Cockcroft JR. Isolated systolic hypertension in the young: a need for clarity. J Hypertens. 2013;31:1911–3.

    Article  CAS  Google Scholar 

  25. Franklin SS, Wilkinson IB, McEniery CM. Unusual hypertensive phenotypes: what is their significance? Hypertension. 2012;59:173–8.

    Article  CAS  Google Scholar 

  26. Protogerou AD, Blacher J, Safar ME. Isolated systolic hypertension: ‘to treat or not to treat’ and the role of central haemodynamics. J Hypertens. 2013;31:655–8.

    Article  CAS  Google Scholar 

  27. Mancia G, Giannattasio C. Diagnostic and therapeutic problems of isolated systolic hypertension. J Hypertens. 2015;33:33–43.

    Article  CAS  Google Scholar 

  28. Sundstrom J, Neovius M, Tynelius P, Rasmussen F. Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts. BMJ. 2011;342:d643.

    Article  Google Scholar 

  29. Yano Y, Stamler J, Garside DB, Daviglus ML, Franklin SS, Carnethon MR, et al. Isolated systolic hypertension in young and middle-aged adults and 31-year risk for cardiovascular mortality: the Chicago Heart Association Detection Project in Industry study. J Am Coll Cardiol. 2015;65:327–35.

    Article  Google Scholar 

  30. Omboni S, Aristizabal D, De la Sierra A, Dolan E, Head G, Kahan T, et al. Hypertension types defined by clinic and ambulatory blood pressure in 14 143 patients referred to hypertension clinics worldwide. Data from the ARTEMIS study. J Hypertens. 2016;34:2187–98.

    Article  CAS  Google Scholar 

  31. Hänninen MR, Niiranen TJ, Puukka PJ, Kesäniemi YA, Kähönen M, Jula AM. Target organ damage and masked hypertension in the general population: the Finn-Home study. J Hypertens. 2013;31:1136–43.

    Article  Google Scholar 

  32. Cuspidi C, Rescaldani M, Sala C, Negri F, Grassi G, Mancia G. Prevalence of electrocardiographic left ventricular hypertrophy in human hypertension: an updated review. J Hypertens. 2012;30:2066–73.

    Article  CAS  Google Scholar 

  33. Cuspidi C, Paoletti F, Tadic M, Sala C, Dell’Oro R, Grassi G, et al. American versus European hypertension guidelines: the case of white coat hypertension. Am J Hypertens. 2020;33:629–33.

    Article  Google Scholar 

  34. Mancia G. Clinical significance of white-coat hypertension. J Hypertens. 2016;34:623–6.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, University of Rome Sapienza, Rome, Italy

    Barbara Citoni, Ilaria Figliuzzi, Vivianne Presta, Vincenzo Cesario, Francesca Miceli, Andrea Ferrucci, Massimo Volpe & Giuliano Tocci

  2. IRCCS Neuromed, Pozzilli, IS, Italy

    Franca Bianchi

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  1. Barbara Citoni
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  2. Ilaria Figliuzzi
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Citoni, B., Figliuzzi, I., Presta, V. et al. Prevalence and clinical characteristics of isolated systolic hypertension in young: analysis of 24 h ambulatory blood pressure monitoring database. J Hum Hypertens 36, 40–50 (2022). https://doi.org/10.1038/s41371-021-00493-9

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