Abstract
Objective: The risk of adverse CV outcomes in young patients with isolated systolic hypertension (ISH) or isolated diastolic hypertension (IDH) is still debated and whether these hypertension subtypes should undergo pharmacological treatment is unclear. Aim of the present the study was to investigate the vascular characteristics and the risk of progression to sisto-diastolic hypertension (SDH) associated with these hypertension subtypes from the HARVEST study. Design and method: We examined 1231 young-to middle age subjects (mean age 33.1 ± 8.6 years, 72.3% males). ISH (11.9%) IDH (22.8%) NT (6.6%) and SDH (58.7%) were defined using the office 140/90 mmHg cutoffs. Vascular stiffness was assessed by radial-carotid pulse wave velocity (PWV) and vascular compliance by radial tonometry among 371 participants. Risk of future hypertension needing antihypertensive treatment was assessed with Cox analysis adjusting for several clinical confounders. Results: Metabolic parameters did not differ significantly among subgroups. Peripheral resistance was 1297.1 ± 326 among NT, 1371.3 ± 281 among ISH, 1502.5 ± 261 among IDH and 1531.6 ± 308 dynesxsecxcm-5 among SDH (p = 0.048 IDH vs NT and <0.001 SDH vs NT), while did not differ significantly between ISH and NT. Large artery compliance was 15.0 ± 4.2, 15.5 ± 4.9, 15.1 ± 4.9 and 14.0 ± 4.3 ml/minx10 respectively, again with similar values between NT and ISH and a significant difference between IDH and SDH p = 0.016. PWV and AIx did not differ significantly among groups, while central SBP was similar among NT, ISH, IDH (122.2 ± 12.0, 122.6 ± 12.4 mmHg respectively, p = n.s.) and higher among SDH (p < 0.001 SHD vs IDH). Progression to sustained HT was 59.2%, 66.4%, 77.9% and 87.5%, in NT, ISH, IDH and SDH respectively, p < 0.001. At cox analysis, considering SDH as reference, ISH presented a lower risk of progression to unfavourable outcome (H.R. 0.70, 95%CI 0.58 - 0.88; p = 0.0023). Conclusions: Young-to-middle age hypertensives have different endothelial function according to different hypertensive subtypes and this may contribute to the future development of hypertension needing treatment. The assessment of vascular function may help to identify those patients who should be treated earlier.
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