21 May Study Suggests Isolated Systolic Hypertension In Young Adults Should Be Treated To Prevent Damage To Aorta
MedicalResearch.com Interview with:
Wanpen Vongpatanasin, M.D.
Professor of Medicine
Norman & Audrey Kaplan Chair in Hypertension
Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research
Director, Hypertension Section,
UT Southwestern Medical Center
Dallas, TX 75390-8586
MedicalResearch.com: What is the background for this study?
Response: It is well know that treatment of isolated systolic hypertension (ISH), a subtype of hypertension with elevated systolic BP 140 or above but normal diastolic BP of < 90 mmHg, improves cardiovascular outcomes in older adults after the sixth decade of life. However, it is controversial if ISH in young adults requires treatment because it was suggested that elevated systolic BP in these individuals are related to high stroke volume, rather than increased aortic stiffness. In earlier case series, ISH in young adults were particularly common in athletes with long arms and legs, suggesting that pulse wave amplification coupled with high stroke volume were responsible for elevated brachial systolic blood pressure but the true central BP was normal. Thus, isolated systolic hypertension was proposed to be a spurious condition in young adults that can be ignored.
However, previous studies used only indirect technique in assessing aortic structure and function. Furthermore, none of these studies were conducted in the U.S. Population.
MedicalResearch.com: What are the main findings?
Response: In our study , we assess stroke volume and aortic stiffness more directly using cardiac MRI in more than 2000 participants under the age of 65 in the Dallas Heart Study. We found that several indices of aortic stiffness, including aortic compliance, aortic pulse wave velocity, and characteristic impedance (Zc) were significantly higher in the isolated systolic hypertension group compared with the optimal blood pressure, isolated diastolic hypertension, or systolic–diastolic hypertension groups. In contrast , stroke volume was not higher in the ISH group than optimal BP group or other hypertension subtype. We also found that aortic size was similar across groups. Normally , when the aorta becomes more stiffness, aorta tends to become enlarged in an attempt to decrease stiffness /resistance to the heart to pump the blood.
We did not find this normal adaptation in individuals with isolated systolic hypertension . Thus, we believe that ISH is not a benign that condition as it is associated with increased stiffness of proximal aorta and the failure of aorta to adapt normally to normalize this stiffness.
MedicalResearch.com: What should readers take away from your report?
Response: Our study suggested that ISH in young adults should be treated sooner than later to prevent further aortic wall damage.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Further studies are needed to determine if hypertension treatment can attenuate decline in compliance of aorta with age in young adults with isolated systolic hypertension and prevent hypertensive target organ damage.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Hemodynamic and Mechanical Properties of the Proximal Aorta in Young and Middle-Aged Adults With Isolated Systolic Hypertension
The Dallas Heart Study
Yuichiro Yano, Ian J. Neeland, Colby Ayers, Ronald Peshock, Jarett D. Berry, Donald M. Lloyd-Jones, Philip Greenland, Gary F. Mitchell, Wanpen Vongpatanasin
Originally published May 15, 2017
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Last Updated on May 21, 2017 by Marie Benz MD FAAD