Abstract P482: Different Hemodynamic Phenotypes Of Isolated Systolic Hypertension In Adolescents

Abstract

Objective: Isolated systolic hypertension (ISH) is a dominant form of primary hypertension (PH) in adolescents. Some of them present with normal central systolic blood pressure (cSBP), a phenomenon called spurious hypertension (sHT). The study was aimed to describe hemodynamics of PH in relation to cSBP, central pulse pressure (cPP) and target organ damage (TOD) in adolescents referred because of PH. Patients and Methods: In 267 children (59 girls; 14.9 ±2.6 years) referred with arterial hypertension, in whom secondary hypertension was excluded, 24 hour ABPM, left ventricular mass index (LVMi), carotid intima-media thickness (cIMT), pulse wave velocity (PWV), cSBP, cPP, cardiac index (CI) and stroke volume (SV) was assessed. 64 age and sex matched normotensive control children were control group. Results: 145 subjects had white coat hypertension (WCH) including 24 with ambulatory prehypertension (ambpreHT). Of 122 hypertensive pts, 39 had ambulatory hypertension (ambHT) and 83 severe ambulatory hypertension (severeHT). Normal cSBP was found in all WCH subject and 23 with ambpreHT. 39 of 122 (32%) hypertensive pts had sHT - 47.4% in those with ambHT and 26.5% with severeHT (p=0.0001). cIMT, LVMi, PWV, cSBP and cPP increased across blood pressure strata from normotension, through sHT to PH with elevated cSBP (all p<0.05). LVMi and cIMT correlated with cSBP (r = 0.220; p = 0.0007; r = 0.14; p = 0.04, respectively) and cPP (r = 0.274; p = 0.0001; r=0.202; p=0.002, respectively). 36 pts with left ventricular hypertrophy (LVH) had greater cPP (52 ±10 mmHg) in comparison with subjects without LVH (47 ±8 mmHg; p = 0.027). Regression analysis revealed cPP as the only predictor of LVMi (r 2 = 0.09, β = 0.143, p = 0.03). ROC area for predictors of LVH revealed similar area under curve for cSBP (0.585), cPP (0.618) and 24h systolic ABPM (0.612). Patients with sHT had greater amplification of pulse pressure than normotensive ones. CI and SV was lowest in normotensive controls, intermediate in sHT patients and highest in patients with elevated cSBP (p<0.05). Conclusions: sHT present with intermediate hemodynamic phenotype between normotension and sustained PH. cSBP and cPP differentiates patients with severeHT and TOD from patients with WCH, ambpreHT and ambHT without TOD