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Isolated Systolic Hypertension in Young and Middle-Aged Adults

Yuichiro Yano1, Donald M Lloyd-Jones2

  • 1Department of Preventive Medicine, Northwestern University Clinical and Translational Sciences (NUCATS) Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Current Hypertension Reports
|October 15, 2016
PubMed

Insights

Isolated systolic hypertension (ISH) in adults under 50 is complex, not always spurious. Tailoring treatment based on individual physiology and cardiovascular risk is crucial for effective management.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Vascular Medicine

Background:

  • Young and middle-aged adults (≤50 years) face rising rates of stroke, kidney disease, and cardiovascular disease (CVD) mortality.
  • Increased prevalence of high blood pressure (BP) is a potential driver of these adverse trends.
  • Management of BP, particularly isolated systolic hypertension (ISH), in this demographic remains uncertain.

Purpose of the Study:

  • To review the current understanding of ISH in young and middle-aged adults.
  • To explore the prevalence, pathophysiology, and treatment strategies for ISH in this population.
  • To address the debate on whether ISH in younger adults is pseudo or spurious hypertension.

Main Methods:

  • Literature review of current research on ISH in adults aged ≤50 years.
  • Analysis of studies examining the heterogeneity of ISH pathophysiology.
  • Synthesis of evidence regarding clinical management approaches.

Main Results:

  • ISH in young and middle-aged adults is a heterogeneous condition, not a monolithic entity.
  • Pathophysiological mechanisms include increased stroke volume, aortic stiffening, or both.
  • Current evidence suggests a "one size fits all" approach to ISH management is inadequate.

Conclusions:

  • Detailed phenotyping of ISH based on individual pathophysiology and global cardiovascular risk is essential.
  • Personalized treatment strategies are needed to assess the net benefit of therapy for ISH.
  • Further research is required to refine diagnostic and therapeutic approaches for ISH in younger adults.

Keywords:
Aortic stiffnessCentral blood pressureIsolated systolic hypertensionPressure amplificationYoung and middle-aged adults

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