Isolated systolic hypertension in the young: a heterogeneous condition

Isolated systolic hypertension in the youth, is still a challenging problem. The prevalence of this hypertensive subtype may vary according to the different population study and is peculiar of male subjects among the youngest age classes. Several are the mechanisms reported as possible underlying causes of isolated systolic blood pressure elevation and again these differ according to the different study cohort and may vary from overweight and obesity status, linked to sympathetic overactivity, to increased and earlier arterial stiffness, hyperkinetic state, or exaggerated pulse pressure amplification form central to peripheral sites, due to enhanced arterial elasticity. Evidence is lacking regarding whether this condition is benign or associated to unfavorable cardiovascular events. The few long-term studies that followed isolated systolic hypertensives in the long-term, again reported conflicting results. Waiting for future studies, some clinical and hemodynamic characteristics of young isolated systolic hypertensives may help clinicians to better characterized patient's risk profile and decide whether to perform a strict follow-up with non-pharmacological measurements or to start drug treatment.