Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be TreatedResponse to Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be Treated: Pro Side of the Argument
Pro Side of the Argument
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Essential hypertension is a common condition, affecting ≈ 25% of the population1,2 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 common form of hypertension in older adults, affecting ≈50% of those aged ≥60 years.4 Historically, ISH in older individuals was viewed as benign and merely part of the natural ageing process. However, evidence from epidemiological and intervention studies now demonstrates that older individuals with ISH have a substantially increased risk of cardiovascular disease5 and benefit substantially from antihypertensive therapy.6–8 The predominant hemodynamic mechanism contributing 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 stiffening 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 adolescents 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 prevalence, particularly in men.16 However, large artery stiffening is not thought to underlie the condition in younger individuals, although the precise mechanisms, and longer-term risks associated with ISH in young people, have been the subject 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, …