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Isolated systolic hypertension in the young

a position paper endorsed by the European Society of Hypertension

Palatini, Paoloa; Rosei, Enrico Agabitib; Avolio, Albertoc; Bilo, Gregorzd,e; Casiglia, Edoardoa; Ghiadoni, Lorenzof; Giannattasio, Cristinag; Grassi, Guidoh; Jelakovich, Bojani; Julius, Stevoj; Mancia, Giuseppek; McEniery, Carmel M.l; O’Rourke, Michael F.m; Parati, Gianfrancod,e; Pauletto, Paoloa; Pucci, Giacomon,o; Saladini, Francescaa; Strazzullo, Pasqualep; Tsioufis, Konstantinosq; Wilkinson, Ian B.l; Zanchetti, Albertor


An author of this article [1] , G. Grassi, states his association with IRCCS Multimedica Sesto San Giovanni, Milan, Italy not previously declared as part of his affiliation.

Journal of Hypertension. 36(10):2120, October 2018.

doi: 10.1097/HJH.0000000000001726

Whether isolated systolic hypertension in the young (ISHY) implies a worse outcome and needs antihypertensive treatment is still a matter for dispute. ISHY is thought to have different mechanisms than systolic hypertension in the elderly. However, findings from previous studies have provided inconsistent results. From the analysis of the literature, two main lines of research and conceptualization have emerged. Simultaneous assessment of peripheral and central blood pressure led to the identification of a condition called pseudo or spurious hypertension, which was considered an innocent condition. However, an increase in pulse wave velocity has been found by some authors in about 20% of the individuals with ISHY. In addition, obesity and metabolic disturbances have often been documented to be associated with ISHY both in children and young adults. The first aspect to consider whenever evaluating a person with ISHY is the possible presence of white-coat hypertension, which has been frequently found in this condition. In addition, assessment of central blood pressure is useful for identifying ISHY patients whose central blood pressure is normal. ISHY is infrequently mentioned in the guidelines on diagnosis and treatment of hypertension. According to the 2013 European Guidelines on the management of hypertension, people with ISHY should be followed carefully, modifying risk factors by lifestyle changes and avoiding antihypertensive drugs. Only future clinical trials will elucidate if a benefit can be achieved with pharmacological treatment in some subgroups of ISHY patients with associated risk factors and/or high central blood pressure.

aDepartment of Medicine, University of Padova, Padua

bDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

cDepartment of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia

dDepartment of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan

eDepartment of Medicine and Surgery, University of Milano-Bicocca

fDepartment of Clinical and Experimental Medicine, University of Pisa, Pisa

gCardiology IV, ‘A. De Gasperis’ Department, ASST Niguarda Ca’ Granda and Medicine and Surgery Department, Bicocca University, Milan

hClinica Medica, University of Milano-Bicocca, Milan, Italy

iUniversity Hospital Center Zagreb, Zagreb, Croatia

jDivision of Hypertension, University of Michigan, Ann Arbor, Michigan, USA

kUniversity of Milano-Bicocca and IRCCS Istituto Auxologico Italiano, Milan, Italy

lDivision of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom

mSt Vincent's Clinic/ University of New South Wales/ VCCRI, Sydney, Australia

nDepartment of Medicine, University of Perugia, Perugia

oUnit of Internal Medicine, Terni University Hospital, Terni

pDepartment of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy

qFirst Cardiology Clinic, National and Kapodistrian University of Athens, Hippokration Hospital, Athens. Greece

rIstituto Auxologico Italiano and Centro Interuniversitario Fisiologia Clinica e Ipertensione, Università degli Studi di Milano, Milan, Italy

Correspondence to Paolo Palatini, MD, Department of Medicine, University of Padova, via Giustiniani, 2, 35128 Padua, Italy. Tel: +39 49 8212278; fax: +39 49 8754179; e-mail:

Abbreviations: AIx, augmentation index; aPWV, aortic pulse wave velocity; BP, blood pressure; BPV, blood pressure variability; CARDIA, Coronary Artery Risk Development in Young Adults; HARVEST, Hypertension and Ambulatory Recording VEnetia STudy; ISH, isolated systolic hypertension; ISHY, isolated systolic hypertension of youth; NHANES, National Health and Nutrition Examination Survey; PP, pulse pressure; PWV, pulse wave velocity; WCE, white-coat effect; WCH, white-coat hypertension

Received 16 December, 2017

Revised 14 February, 2018

Accepted 16 February, 2018

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