What is the clinical evidence from this study?

Study design: Cohort. Population: Isolated systolic and diastolic hypertension (n=1201). Intervention: Isolated systolic hypertension (ISH) vs. Isolated diastolic hypertension (IDH). Primary outcome: Major adverse cardiovascular events (MACE) (HR 2.8, 95% CI 1.5-5.2, p=0.001).

What does this research mean for the field?

In young adults, isolated systolic hypertension identified by ambulatory blood pressure monitoring significantly increases the risk of major adverse cardiovascular events, whereas ambulatory isolated diastolic hypertension carries no increased risk compared to normal blood pressure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 3, 2026

Isolated Systolic Hypertension and Isolated Diastolic Hypertension Identified With Ambulatory Blood Pressure: Longitudinal Association With Cardiovascular Events in the Young

Key Result

Ambulatory isolated systolic hypertension in young adults was associated with higher MACE risk compared to isolated diastolic hypertension (HR 2.8; 95% CI 1.5-5.2; p=0.001).

Key Points

The study aims to determine the predictive value of isolated diastolic hypertension (IDH) and isolated systolic hypertension (ISH) on major adverse cardiovascular events (MACE) in younger individuals.
Investigated 1201 subjects aged 33.1±8.5 years using 24-hour ambulatory BP measurement.
Calculated MACE risk in different hypertension groups (normal BP, IDH, ISH, and systolic-diastolic hypertension) using multivariate Cox regressions.
Followed participants for 19 years to assess outcomes.
HR for MACE was 2.8 (95% CI, 1.5-5.2, p=0.001) in ISH and 2.1 (95% CI, 1.3-3.4, p=0.003) in SDH compared to IDH.
Pulse pressure was a significant predictor of MACE (p=0.011), while mean BP was not (p=0.59).
No significant correlation was found between office BP measurements and ambulatory IDH or ISH.

Study Design

Type

Cohort (n=1,201)

Structured PICO

Does isolated systolic hypertension or systolic-diastolic hypertension identified by ambulatory BP increase the risk of MACE compared to isolated diastolic hypertension in young subjects?

Population

1,201 young adults (mean age 33.1 years, 27.2% female) with varying blood pressure profiles identified via 24-hour ambulatory monitoring, followed for 19 years.

Exposure

Isolated systolic hypertension (ISH) and systolic-diastolic hypertension (SDH) identified with 24-hour ambulatory blood pressure monitoring (using 130/80 mmHg cut-off)

Comparator

Isolated diastolic hypertension (IDH) identified with 24-hour ambulatory blood pressure monitoring

Outcome

Major adverse cardiovascular events (MACE)composite

In young subjects, ambulatory isolated systolic hypertension and systolic-diastolic hypertension are associated with a significantly higher risk of MACE compared to isolated diastolic hypertension.

Main Result

Hazard Ratio: 2.8 (95% CI 1.5–5.2)

p-value: p=0.001

Abstract

Objective: The clinical relevance and adverse consequences of isolated diastolic hypertension (IDH) and isolated systolic hypertension (ISH) in young people have been questioned. Most results were obtained with office blood pressure (BP) while only a few data were based on out-of-office BP. The aim of the present study was to investigate the predictive value for major adverse cardiovascular events (MACE) of IDH and ISH of the young identified with 24-hour ambulatory BP. Design and method: We investigated 1201 subjects with mean age 33.1±8.5 years, 72.8% males. Using the 130/80 mmHg 24-hour BP cut-off, 269 participants had normal BP, 277 had IDH, 206 had ISH, and 449 had systolic-diastolic hypertension (SDH). The risk of MACE in the four groups was calculated using multivariate Cox regressions. Results: Office IDH and ISH were poorly correlated with ambulatory IDH and ISH (R=0.35 and 0.32, respectively). During 19 years of follow-up, there were a total of 136 MACE. In multivariate Cox regression adjusted for age, gender, parental cardiovascular disease, smoking, alcohol, coffee use, physical activity, body mass index, serum glucose, total cholesterol, and HDL-cholesterol, the lowest hazard ratio (HR) of MACE was found in the IDH participants who were taken as the reference group. Compared to IDH, the HR was 2.8 (95%CI,1.5-5.2, p=0.001) in ISH and 2.1 (1.3-3.4, p=0.003) in SDH. No significant difference was found between IDH and the normal ambulatory BP group. Inclusion of office BP and antihypertensive treatment during follow-up in the model only marginally affected the difference between the groups. Using ambulatory BP as a continuous variable, pulse pressure (p=0.011) but not mean BP (p=0.59) was a significant predictor of outcome. No group defined according to office BP was independently associated with MACE. Conclusions: These data indicate that in young subjects, IDH identified according to ambulatory BP is at lower risk of MACE compared to ISH and SDH. Patients with ambulatory ISH are at high risk of cardiovascular disease to the same extent as those with SDH and should be given antihypertensive treatment. Pulse pressure assessed with ambulatory monitoring has important prognostic value also in young individuals.

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