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The ratio of early diastolic transmitral velocity to early diastolic tissue velocity correlates with invasively measured LVDP during exercise. It can be used to reliably identify patients with elevated LVDP during exercise and reduced exercise capacity.

Abstract-Isolated systolic hypertension is a common condition in individuals aged older than 60 years. However, isolated systolic hypertension has also been described in young individuals, although the mechanisms are poorly understood. We hypothesized that in young adults, isolated systolic hypertension and essential hypertension have different hemodynamic mechanisms and the aim of this study was to test this hypothesis in a cohort of subjects from The ENIGMA Study. Peripheral and central blood pressure, aortic pulse wave velocity, cardiac output, stroke volume, and peripheral vascular resistance were determined in 1008 subjects, aged 17 to 27 years. Compared with normotensive subjects, those with isolated systolic hypertension had significantly higher peripheral, central, and mean blood pressure, aortic pulse wave velocity, cardiac output, and stroke volume (PϽ0.001 for all comparisons). However, there were no differences in pulse pressure amplification, heart rate, or peripheral vascular resistance between the two groups. Compared with subjects with essential hypertension, mean pressure, heart rate, and peripheral vascular resistance were all significantly lower in isolated systolic hypertensive subjects, but pulse pressure amplification, aortic pulse wave velocity, cardiac output, and stroke volume were higher (PϽ0.001 for all comparisons). We have demonstrated that in young adults, isolated systolic hypertension and essential hypertension arise from different hemodynamic mechanisms. Isolated systolic hypertension appears to result from an increased stroke volume and/or aortic stiffness, whereas the major hemodynamic abnormality underlying essential hypertension is an increased peripheral vascular resistance. Long-term follow-up of these individuals is now required to determine whether they are at increased risk compared with age-matched normotensive individuals. Key Words: arterial stiffness Ⅲ hemodynamics Ⅲ isolated systolic hypertension Ⅲ stroke volume Ⅲ young adults H ypertension is a common disorder, affecting Ϸ25% of the overall population 1,2 and is a major risk factor for cardiovascular disease. Epidemiological data 2,3 not only show an age-related change in the incidence of hypertension but also in its form. In those aged younger than 50, the predominant form of hypertension is essential hypertension (EH), involving elevation of systolic (SBP) and diastolic pressure (DBP), or DBP alone, which is characterized by increased peripheral vascular resistance (PVR). However, in older individuals, the most common form of hypertension is isolated systolic hypertension (ISH). This affects Ϸ50% of those aged older than 60 4 and, in contrast to EH, is thought to be caused mainly by large artery stiffening, resulting from disruption and fatigue-fracture of elastic fibers. Therefore, ISH is often considered to be an exaggeration of "normal" age-related stiffening seen in most populations. Indeed, we 5 and others 6 have shown that aortic pulse wave velocity (PWV), a measure of arterial stiffness, is increased in pa...

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Abstract-Exercise brachial blood pressure (BP) predicts mortality, but because of wave reflection, central (ascending aortic) pressure differs from brachial pressure. Exercise central BP may be clinically important, and a noninvasive means to derive it would be useful.

An HRE at moderate exercise intensity during exercise stress testing is an independent risk factor for CV events and mortality. This highlights the need to determine underlying pathophysiological mechanisms of exercise-induced hypertension.

Automated recording of waveforms, calibrated noninvasively by brachial mean arterial pressure/DBP values seems the most promising approach that can provide relatively more accurate, noninvasive estimation of a-SBP. It is still uncertain whether a specific device can be recommended as 'gold standard'; however, a consensus is currently demanding.