Isolated systolic hypertension in the young: a position paper endorsed by the European Society of Hypertension

Paolo Palatini, Enrico Agabiti Rosei, Alberto Avolio, Gregorz Bilo, Edoardo Casiglia, Lorenzo Ghiadoni, Cristina Giannattasio, Guido Grassi, Bojan Jelakovich, Stevo Julius, Giuseppe Mancia, Carmel M McEniery, Michael F O'Rourke, Gianfranco Parati, Paolo Pauletto, Giacomo Pucci, Francesca Saladini, Pasquale Strazzullo, Konstantinos Tsioufis, Ian B WilkinsonAlberto Zanchetti

Research output: Contribution to journalArticle

Abstract

: Whether isolated systolic hypertension in the young (ISHY) implies a worse outcome and needs antihypertensive treatment is still a matter for dispute. ISHY is thought to have different mechanisms than systolic hypertension in the elderly. However, findings from previous studies have provided inconsistent results. From the analysis of the literature, two main lines of research and conceptualization have emerged. Simultaneous assessment of peripheral and central blood pressure led to the identification of a condition called pseudo or spurious hypertension, which was considered an innocent condition. However, an increase in pulse wave velocity has been found by some authors in about 20% of the individuals with ISHY. In addition, obesity and metabolic disturbances have often been documented to be associated with ISHY both in children and young adults. The first aspect to consider whenever evaluating a person with ISHY is the possible presence of white-coat hypertension, which has been frequently found in this condition. In addition, assessment of central blood pressure is useful for identifying ISHY patients whose central blood pressure is normal. ISHY is infrequently mentioned in the guidelines on diagnosis and treatment of hypertension. According to the 2013 European Guidelines on the management of hypertension, people with ISHY should be followed carefully, modifying risk factors by lifestyle changes and avoiding antihypertensive drugs. Only future clinical trials will elucidate if a benefit can be achieved with pharmacological treatment in some subgroups of ISHY patients with associated risk factors and/or high central blood pressure.

Original languageEnglish
Pages (from-to)1222-1236
Number of pages15
JournalJournal of Hypertension
Volume36
Issue number6
DOIs
Publication statusPublished - Jun 2018

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Hypertension
Blood Pressure
Antihypertensive Agents
White Coat Hypertension
Guidelines
Pulse Wave Analysis
Dissent and Disputes
Life Style
Young Adult
Therapeutics
Obesity
Clinical Trials
Pharmacology
Research

Cite this

Palatini, P., Rosei, E. A., Avolio, A., Bilo, G., Casiglia, E., Ghiadoni, L., ... Zanchetti, A. (2018). Isolated systolic hypertension in the young: a position paper endorsed by the European Society of Hypertension. Journal of Hypertension, 36(6), 1222-1236. https://doi.org/10.1097/HJH.0000000000001726

Isolated systolic hypertension in the young : a position paper endorsed by the European Society of Hypertension. / Palatini, Paolo; Rosei, Enrico Agabiti; Avolio, Alberto; Bilo, Gregorz; Casiglia, Edoardo; Ghiadoni, Lorenzo; Giannattasio, Cristina; Grassi, Guido; Jelakovich, Bojan; Julius, Stevo; Mancia, Giuseppe; McEniery, Carmel M; O'Rourke, Michael F; Parati, Gianfranco; Pauletto, Paolo; Pucci, Giacomo; Saladini, Francesca; Strazzullo, Pasquale; Tsioufis, Konstantinos; Wilkinson, Ian B; Zanchetti, Alberto.

In: Journal of Hypertension, Vol. 36, No. 6, 06.2018, p. 1222-1236.

Research output: Contribution to journalArticle

Palatini, P, Rosei, EA, Avolio, A, Bilo, G, Casiglia, E, Ghiadoni, L, Giannattasio, C, Grassi, G, Jelakovich, B, Julius, S, Mancia, G, McEniery, CM, O'Rourke, MF, Parati, G, Pauletto, P, Pucci, G, Saladini, F, Strazzullo, P, Tsioufis, K, Wilkinson, IB & Zanchetti, A 2018, 'Isolated systolic hypertension in the young: a position paper endorsed by the European Society of Hypertension', Journal of Hypertension, vol. 36, no. 6, pp. 1222-1236. https://doi.org/10.1097/HJH.0000000000001726
Palatini, Paolo ; Rosei, Enrico Agabiti ; Avolio, Alberto ; Bilo, Gregorz ; Casiglia, Edoardo ; Ghiadoni, Lorenzo ; Giannattasio, Cristina ; Grassi, Guido ; Jelakovich, Bojan ; Julius, Stevo ; Mancia, Giuseppe ; McEniery, Carmel M ; O'Rourke, Michael F ; Parati, Gianfranco ; Pauletto, Paolo ; Pucci, Giacomo ; Saladini, Francesca ; Strazzullo, Pasquale ; Tsioufis, Konstantinos ; Wilkinson, Ian B ; Zanchetti, Alberto. / Isolated systolic hypertension in the young : a position paper endorsed by the European Society of Hypertension. In: Journal of Hypertension. 2018 ; Vol. 36, No. 6. pp. 1222-1236.
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T2 - a position paper endorsed by the European Society of Hypertension

AU - Palatini, Paolo

AU - Rosei, Enrico Agabiti

AU - Avolio, Alberto

AU - Bilo, Gregorz

AU - Casiglia, Edoardo

AU - Ghiadoni, Lorenzo

AU - Giannattasio, Cristina

AU - Grassi, Guido

AU - Jelakovich, Bojan

AU - Julius, Stevo

AU - Mancia, Giuseppe

AU - McEniery, Carmel M

AU - O'Rourke, Michael F

AU - Parati, Gianfranco

AU - Pauletto, Paolo

AU - Pucci, Giacomo

AU - Saladini, Francesca

AU - Strazzullo, Pasquale

AU - Tsioufis, Konstantinos

AU - Wilkinson, Ian B

AU - Zanchetti, Alberto

PY - 2018/6

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N2 - : Whether isolated systolic hypertension in the young (ISHY) implies a worse outcome and needs antihypertensive treatment is still a matter for dispute. ISHY is thought to have different mechanisms than systolic hypertension in the elderly. However, findings from previous studies have provided inconsistent results. From the analysis of the literature, two main lines of research and conceptualization have emerged. Simultaneous assessment of peripheral and central blood pressure led to the identification of a condition called pseudo or spurious hypertension, which was considered an innocent condition. However, an increase in pulse wave velocity has been found by some authors in about 20% of the individuals with ISHY. In addition, obesity and metabolic disturbances have often been documented to be associated with ISHY both in children and young adults. The first aspect to consider whenever evaluating a person with ISHY is the possible presence of white-coat hypertension, which has been frequently found in this condition. In addition, assessment of central blood pressure is useful for identifying ISHY patients whose central blood pressure is normal. ISHY is infrequently mentioned in the guidelines on diagnosis and treatment of hypertension. According to the 2013 European Guidelines on the management of hypertension, people with ISHY should be followed carefully, modifying risk factors by lifestyle changes and avoiding antihypertensive drugs. Only future clinical trials will elucidate if a benefit can be achieved with pharmacological treatment in some subgroups of ISHY patients with associated risk factors and/or high central blood pressure.

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