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: Con Side of the Argument
Con Side of the Argument
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Isolated systolic hypertension (ISH) in young people, defined on the basis of brachial blood pressure (BP) as a systolic BP (SBP) of at least 140 mm Hg with a diastolic BP (DBP) of <90 mm Hg, is not an unusual condition and is increasing in prevalence.1–3 To date, this concept has been confronted with challenges in the mechanisms, clinical relevance, and consequences. Parameters other than brachial BP, such as noninvasive central hemodynamics, have introduced new insights to the condition. Nevertheless, grounded information supporting the long-term consequences is still lacking; therefore, the necessity to decide to treat or not to treat is a matter of concern in clinical practice.4 The current knowledge of ISH in young people is presented with an emphasis on the elements that are relevant to deciding that treatment is not needed.
The prevalence of ISH reported among the young ranges widely, from 2% to 8% in population studies, and between 14% and 50% in patients with hypertension.3 This is a result of the differences in population characteristics, such as age, ethnicity, and obesity. The Enigma study in the UK confirmed that ISH is the most common form of hypertension (HTN) in young adults aged 17 to 27 years, with a prevalence of 8%.1 Data from the National Health and Nutrition Examination Survey indicate that among younger and middle-aged adults in the US, aged 18 to 39 years, the overall prevalence of ISH between 1988 and 1994 was 0.7%. This reached 1.6% (2.23% in males and 0.92% in females) between 1999 and 2004. Obesity, smoking, and low socioeconomic status seem to be important determinants of ISH among young adults.2 In a United States pediatric population of 12- to 16-year olds, the most prevalent hypertensive subtype was ISH.5 Similarly, in Spanish obese youths, …