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(Hypertension. 2005;46:221.)
© 2005 American Heart Association, Inc.

Fifth International Workshop on Structure and Function of Large Arteries

Increased Stroke Volume and Aortic Stiffness Contribute to Isolated Systolic Hypertension in Young Adults

Carmel M. McEniery; Yasmin; Sharon Wallace; Kaisa Maki-Petaja; Barry McDonnell; James E. Sharman; Christopher Retallick; Stanley S. Franklin; Morris J. Brown; R. Catherine Lloyd; John R. Cockcroft; Ian B. Wilkinson on behalf of the ENIGMA Study Investigators

From Clinical Pharmacology Unit (C.M.M., Y., S.W., K.M.-P., M.J.B., I.B.W.), University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK; Wales Heart Research Institute (B.M., J.E.S., Y., S.W., R.C.L., J.R.C.), Cardiff University, University Hospital, Cardiff, UK; Department of Medicine (S.S.F.), University of California, Irvine, Calif; and School of Applied Sciences (C.R.), University of Glamorgan, Pontypridd, UK.

Correspondence to Dr Carmel McEniery, Clinical Pharmacology Unit, University of Cambridge, Addenbrooke’s Hospital Box 110, Cambridge, CB2 2QQ, UK. E-mail cmm41{at}cam.ac.uk

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 (P<0.001 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 (P<0.001 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 • hemodynamics • isolated systolic hypertension • stroke volume • young adults

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