• Isolated systolic hypertension in young patients increases mortality

    May 21, 2015

    People between 18 and 49 years of age with isolated systolic hypertension (ISH) have increased risk of death from cardiovascular causes or ischemic heart disease (IHD) according to the results of a study published in the Journal of the American College of Cardiology.

    The authors used a database of patients from 1967 to 2003 and evaluated the risk of developing cardiovascular disease (CVD) in the presence of ISH, defined as systolic blood pressure (SBP)> / = 140 mmHg and diastolic blood pressure (DBP) <90 mmHg in men and women under the age of 50.


    27,081 participants were classified into five categoriesm, based on the values of BP: optimal BP (SBP <130 DBP <85 mmHg); high normal BP (130-139 / 85-89 mmHg); ISH (SBP> / = 140 mmHg and DBP <90 mmHg); isolated diastolic hypertension (IDH; SBP <140 and DBP> / = 90 mmHg) and systolic – diastolic hypertension (SDH; SBP> / = 140 mmHg and DBP> / = 90 mmHg).


    According to this distribution, 53% of the women had optimal baseline BP and 13% – ISH, while among men – around 25% of the participants fell into each category: optimal blood pressure, high normal BP and ISH. Patients with known coronary artery disease and those taking antihypertensive medications were excluded.

    The results showed that after 31 years of follow up the participants with baseline ISH were at increased risk for CVD and CHD mortality as compared to those who had optimal or normal blood pressure or high IDH. The relationship described was more pronounced in women. The risk in patients with ISH, however, was lower than that in patients with SDH.


    Up to that point ISH at a young age had not attracted particular attention as a risk factor, but the data from this study showed that ISH was associated with an increased risk of CVD and mortality.

    Since the frequency of hypertension, obesity and lipid profile disorders among young people have been increasing substantially, early intervention in the course of the disease and the promotion of a healthy lifestyle could significantly influence the future incidence of adverse cardiovascular events.

    According to the Guidelines for the Management of Arterial Hypertension of the European Society of Cardiology and the European Society of Hypertension (ESC / ESH), the preferred antihypertensive drugs for adults with ISH are calcium channel blockers (CCBs) and diuretics with class indication ΙA.

    Some meta-analyzes suggest that CCBs may be more effective than other antihypertensive classes for stroke prevention (perhaps precisely because of the favorable influence of SBP, whose values are closely associated with stroke risk).
    In addition, this class of drugs has been shown to lower the central aortic pressure, improving the endothelial function, and it also has antiatherosclerotic effects.