Spurious systolic hypertension in youth

O’Rourke, Michael; Vlachopoulos, Charalambos; Graham, Robert M.

doi:10.1177/1358836x0000500303

Cited by 139 publications

(111 citation statements)

References 14 publications

(20 reference statements)

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“…However, the mean age of our study population was 27.8 7 3.7 years and, thus, widely eliminating age-related changes of the cardiovascular system. While cardiovascular phenomena such as spurious systolic hypertension have been reported in young individuals, 42 we believe that our study population ranging from 23 to 35 years also remains largely unaffected by such maturational changes during growth.…”

Section: Discussionmentioning

confidence: 91%

Diastolic blood pressure is an important determinant of augmentation index and pulse wave velocity in young, healthy males

Nürnberger¹,

Dammer²,

Saez

et al. 2003

J Hum Hypertens

118

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Pulse wave velocity (PWV) and augmentation index are widely used measures of arterial stiffness. The purpose of this study was to evaluate the role of blood pressure as a determinant of both indices independent of potentially confounding factors including gender, age and cardiovascular disorders. A total of 77 young, healthy subjects were investigated under resting conditions. Augmentation index was derived by pulse wave analysis using carotid applanation tonometry. PWV was determined from pressure tracing over the carotid and femoral artery. The relations between stiffness markers and haemodynamic parameters were analysed by simple (r) and multiple (b) regression analysis. Using simple regression analysis, augmentation index was correlated to age (r ¼ 0.292, P ¼ 0.0105), diastolic blood pressure (DBP, r ¼ 0.483, Po0.0001), mean arterial blood pressure (MAP, r ¼ 0.381, P ¼ 0.0007), pulse pressure (r ¼ À0.414, P ¼ 0.0002) and total peripheral resistance (r ¼ 0.266, P ¼ 0.0204). After multiple regression analysis, augmentation index remained significantly correlated only to DBP (b ¼ 0.347, P ¼ 0.0051). Using simple regression analysis, PWV was correlated to age (r ¼ 0.304, P ¼ 0.0067), systolic blood pressure (r ¼ 0.280, P ¼ 0.0129). DBP (r ¼ 0.455, Po0.0001), MAP (r ¼ 0.446, Po0.0001) and heart rate (r ¼ 0.348, P ¼ 0.0018). After multiple regression analysis, PWV remained correlated only to age (b ¼ 0.218, P ¼ 0.0422) and DBP (b ¼ 0.4105, P ¼ 0.0316). In summary, DBP is an important determinant of augmentation index and PWV in young, healthy males. Further studies are needed to characterize the impact of blood pressure on arterial stiffness in other populations including females and older subjects.

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Section: Discussionmentioning

confidence: 91%

Diastolic blood pressure is an important determinant of augmentation index and pulse wave velocity in young, healthy males

Nürnberger¹,

Dammer²,

Saez

et al. 2003

J Hum Hypertens

118

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“…Such a phenomenon might be more common in tall subjects with low aortic pulse wave velocity, and therefore might be more common in young adult males than in young adult females because the former tend to be taller. 10 It has also been shown 11 that the arteries of young subjects with ISH, far from being stiff, tend to be highly elastic (nonsmokers and athletes). This is the background to the idea of 'spurious' or 'pseudo'-systolic hypertension in young men.…”

Section: Discussionmentioning

confidence: 99%

“…O'Rourke found that ISH is 'not uncommon' in young healthy adults of between 15 and 25 years of age 10 and Mahmoud and Feely 11 found a prevalence of 12.6% in a population of 174 healthy, male medical students.…”

Section: Discussionmentioning

confidence: 99%

“…It was recently proposed 10,11,20 that an isolated increase in SBP and PP elevation in young subjects might represent nothing more than an unusually high amplification of the initial pressure wave. Such a phenomenon might be more common in tall subjects with low aortic pulse wave velocity, and therefore might be more common in young adult males than in young adult females because the former tend to be taller.…”

Section: Discussionmentioning

confidence: 99%

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Isolated systolic hypertension: data on a cohort of young subjects from a French working population (IHPAF)

Hamici

Châtellier³

et al. 2003

J Hum Hypertens

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Elderly patients with isolated systolic hypertension (ISH)Fsystolic blood pressure (SBP) X140 mmHg and diastolic blood pressure (DBP) o90 mmHgFhave increased mortality and morbidity. The aim was to study the incidence of ISH in a younger population of between 15 and 60 years of age, and to measure pulse pressure (PP), mean arterial pressure (MAP) and heart rate (HR) in these subjects. The study population consisted of 27 783 subjects, aged 15-60 years, untreated for hypertension (HT) from a cohort of employees formed to study the incidence of HT in the French working population (AIHFP). BP and HR were measured with a validated, automatic device after 5, 6 and 7 min at rest. The prevalence of ISH was 6.9% in men, 2.3% in women. This prevalence was over 5% in young men and increased at 40-44 years; it was negligible in young women, but increased at 50-54 years to about 10% (ie to the same level as in men of the same age): PP in subjects with ISH (46.9 mmHg) was significantly higher than in the normotensive group (NTF40.9 mmHg); it was comparable in both young men (65.5 mmHg) and older men (66 mmHg); it was higher in men (63.1 mmHg) than in women (61.5 mmHg). HR was higher in ISH than in NT and it was higher in women (E5 bpm) in whom it decreased with age. The prevalence of ISH is not negligible in HT (30% men, 25% women), with a high prevalence in young subjects and elevated PP, MAP and HR values. These data should be taken into account as elevated ISH, PP and HR are considered as cardiovascular risk factors.

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“…Moreover, the phenomenon of spurious systolic hypertension, that is, the disproportional increase of brachial SBP with low aortic SBP has been repeatedly described in youths. 33 This phenomenon is related to the complex arterial mechanical properties (wave reflections, their timing and anthropometric parameters that is, height) and it may be potentially explained by the presence of low pressure wave reflections in the presence of obesity. 34 Finally, it should be stated that the present results may have been modulated by (i) the fact that the normal ranges of HBP have been derived from the same population, 24 whereas OBP cutoffs are based on international guidelines; 35 and (ii) the fact that OBP thresholds are based on the auscultatory method compared with the oscillometric devices that were used in this study.…”

Section: Perspectives and Limitationsmentioning

confidence: 99%

Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study

et al. 2009

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Obesity is related to office blood pressure (OBP). Important discrepancies exist between OBP and home blood pressure (HBP), providing complementary information for the management of hypertension. The association between obesity and HBP has not been investigated in children. The evidence on the role of obesity in the predominance of systolic blood pressure (SBP) over diastolic (DBP) in paediatric hypertension is limited. A total of 778 healthy subjects aged 6-18 years were recruited in this study. OBP and HBP were measured using electronic devices validated in children. Anthropometric measurements were measured and expressed as z-scores for height or age. Among all indices of obesity (z-scores), body mass index (BMI) showed the best association with BP. The effect of obesity (BMI) was more pronounced on: (i) SBP than DBP and (ii) H-SBP than O-SBP (O-SBP: r 2 ¼ 0.09, O-DBP: r 2 ¼ 0.05, H-SBP: r 2 ¼ 0.12, H-DBP: r 2 ¼ 0.06). The prevalence of systolic hypertension was higher than that of diastolic hypertension. This difference was significant only in office readings and independent from obesity (normal weight: 6.3% systolic hypertension versus 1.2% diastolic; obese: 37.9% versus 6.9%, Po0.05 for both). These data imply that in children and adolescents the z-score of BMI is the most appropriate index of the association between BP and obesity. It also suggests that obesity is probably more closely associated with home than office BP. Finally, although obesity appears to affect SBP more than DBP, these results suggest that the predominance of systolic hypertension in children and adolescents might not be only related to obesity but also to the measurement setting (office).

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Spurious systolic hypertension in youth

Cited by 139 publications

References 14 publications

Diastolic blood pressure is an important determinant of augmentation index and pulse wave velocity in young, healthy males

Diastolic blood pressure is an important determinant of augmentation index and pulse wave velocity in young, healthy males

Isolated systolic hypertension: data on a cohort of young subjects from a French working population (IHPAF)

Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study

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