Key result
Isolated systolic hypertension in adolescents was associated with a higher prevalence of left ventricular hypertrophy compared to white-coat hypertension (47% vs. 14%, P=0.002).
Why the study?
Despite its high prevalence among hypertensive adolescents, the clinical significance of isolated systolic hypertension is not determined, and whether ISH with normal central blood pressure represents a benign phenomenon remains unclear.
Does isolated systolic hypertension associate with increased left ventricular mass index and aortic stiffness compared to white-coat hypertension in adolescents?
Observational (n=73)
Does isolated systolic hypertension associate with increased left ventricular mass index and aortic stiffness compared to white-coat hypertension in adolescents?
Absolute Event Rate: 47% vs 14%
p-value: p=0.002
Isolated systolic hypertension in adolescents, including the spurious hypertension subtype with normal central blood pressure, is associated with increased markers of cardiac end-organ damage and aortic stiffness, suggesting it is not a benign phenomenon.
Adolescent ISH, including sHTN, should not be dismissed as benign; challenges the spurious-hypertension hypothesis and leaves open treatment need.
OBJECTIVES: Despite the high prevalence of isolated systolic hypertension (ISH) among hypertensive adolescents, its clinical significance is not determined. In addition, it is hypothesized that ISH with normal central blood pressure (BP) in young patients is a benign phenomenon and was hence labeled spurious hypertension (sHTN). METHODS: Using cardiac magnetic resonance we evaluated a group of 73 patients with suspected primary hypertension, aged 13-17 years (median: 16.9, interquartile range 15.8-17.4; 13 girls), in whom, based on 24-h ambulatory BP monitoring either ISH (n = 30) or white-coat hypertension (WCH) (n = 43) was diagnosed. Based on noninvasive central BP measurement 13 participants in the ISH group were classified as having sHTN and 17 were diagnosed with true hypertension. RESULTS: Compared with WCH adolescents, ISH patients presented with higher indexed left ventricular mass index (LVMI) (P < 0.001), maximal left ventricular (LV) wall thickness (P < 0.001), LV concentricity (P = 0.001) and more often had LV hypertrophy (47 vs. 14%, P = 0.002). They had higher average pulse wave velocity (PWV) in the proximal aorta (P = 0.016) and the whole thoracic aorta (P = 0.008). In addition, we observed higher indexed LV stroke volume (P = 0.025) in patients with ISH. The sHTN subgroup had significantly higher LVMI and aortic PWV, and more often had LV hypertrophy compared with the WCH group. The sHTN and true hypertension subgroups did not differ in terms of aortic PWV, LVMI or LV geometry. CONCLUSION: Compared with adolescents with WCH patients with ISH, including the sHTN subtype, have more pronounced markers of cardiac end-organ damage, higher aortic stiffness and stroke volume.
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A 2022 study conducted an observational in suspected primary hypertension (n=73). Isolated systolic hypertension vs. White-coat hypertension was evaluated on left ventricular (LV) hypertrophy (p=0.002). Isolated systolic hypertension in adolescents was associated with a higher prevalence of left ventricular hypertrophy compared to white-coat hypertension (47% vs. 14%, P=0.002).
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