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

Abstract

essential hypertension is a common condition, affecting 1,2 ≈ 25% of the population and is the leading cause of death and disability worldwide.3 no longer viewed as a single disorder, essential hypertension has many different forms, including isolated systolic hypertension (isH), the most com- mon form of hypertension in older adults, affecting ≈50% of those aged ≥60 years.4 Historically, isH in older individu- als was viewed as benign and merely part of the natural age- ing process. However, evidence from epidemiological and intervention studies now demonstrates that older individuals with isH have a substantially increased risk of cardiovascu- lar disease5 and benefit substantially from antihypertensive therapy.6–8 the predominant hemodynamic mechanism con- tributing to isH in older individuals is increased aortic pulse wave velocity,9,10 a robust marker of arterial stiffness, and a key determinant of cardiovascular mortality.11 Arterial stiff- ening leads to an increase in pulse pressure (pp) and a vicious cycle of further stiffening and end-organ effects driving the increased cardiovascular risk.12 interestingly, isH is not limited to older individuals. Many population and observation studies demonstrate that isH is also the most common form of hypertension in ado- lescents and young adults.13–15 Moreover, data from the 1999 to 2004 national Health and nutrition examination survey demonstrate that isH in young adults is increasing in preva- lence, particularly in men.16 However, large artery stiffening is not thought to underlie the condition in younger indi- viduals, although the precise mechanisms, and longer-term risks associated with isH in young people, have been thesubject of continued debate.17,18 indeed, the terms spurious and pseudo have been applied to isH in young subjects. We think that isH in young people is associated with increased future risk and requires careful evaluation and treatment. As such, the terms spurious and pseudo hypertension are unjustified.