High Pulse Pressure and Low Mean Pressure Are Favorable Features in Young Adults
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
See related article, pp 537–542
Saladini et al1 discussed this topic and related issues at a Satellite Meeting of the European Society of Hypertension in June 2017. The subject is controversial; it bears on whether or not young persons with elevated systolic pressure (SP) and pulse pressure (PP), but normal diastolic pressure (DP; and mean pressure [MP]), are at high risk and warrant the same management as in persons over age 60 years. One also needs to reconsider what brachial cuff blood pressure indices are most important—SP, DP, MP, or PP, and of course, what is “young.”
Saladini et al1 studied a cohort (n=1241) of the HARVEST trial (Hypertension and Ambulatory Recording Venetia Study)2 aged 18 to 45 years and concentrated on PP and MP. In a similar study from Chicago, Yano et al3 considered a similar age group (18–49 years) with an even longer follow-up (31 compared to 12 years), but concentrated on the usual measures of SP and DP. Results were similar in these 2 studies, showing that elevation of SP or PP alone (ie, isolated systolic hypertension) had no adverse risk and could be considered as innocuous (provided that follow-up and lifestyle measures were addressed). Results were quite different to those of the SHEP study (Systolic Hypertension in the Elderly Program)4 in 1991, and Syst-Eur (Systolic Hypertension in Europe trial) and Syst-China (Systolic Hypertension in China trial) that followed. Benetos et al5 had previously suggested that blood pressure issues be characterized according to MP and PP because MP showed little fall along the arterial tree to arterioles and is thus related to peripheral resistance and mean flow, whereas PP is determined by properties of the conduit arteries, and so to degeneration with aging, or to wave amplification from left ventricle to …