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Guidelines on guidelines: focus on isolated systolic hypertension in youth

O’Rourke, Michael F.a,b; Adji, Audreya,c

doi: 10.1097/HJH.0b013e32835d8230

Current guidelines on isolated systolic hypertension (ISH) suggest the same treatment to patients of all ages. Application of these guidelines in youth with ISH may not be appropriate, as presently no data show adverse outcome or benefit of drug therapy in this group. Simple noninvasive tonometric techniques now enable physicians to measure the central aortic pressure waveform and amplification of the pressure pulse. ISH in youth is usually caused by high amplification of the central pressure wave, whereas ISH in the elderly (>age 60) is attributable to aortic stiffening. This is the only group with ISH shown to have an adverse prognosis and to warrant drug therapy.

aSt Vincent's Clinic, Sydney

bUniversity of New South Wales and Victor Chang Cardiac Research Institute

cAustralian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia

Correspondence to Professor Michael O’Rourke, St Vincent's Clinic, Suite 810, 438 Victoria Street, Darlinghurst NSW 2010, Sydney, Australia. Tel: +61 02 8382 6874; fax: +61 02 8382 6875; e-mail:

Abbreviations: ESC, European Society of Cardiology; ESH, European Society of Hypertension; ISH, Isolated Systolic Hypertension; ISHY, Isolated Systolic Hypertension in youth; NIH, National Institutes of Health; SHEP, Isolated Systolic Hypertension in the Elderly Project

Received 13 August, 2012

Revised 23 October, 2012

Accepted 4 December, 2012

© 2013 Lippincott Williams & Wilkins, Inc.