Central hemodynamic characteristics of young adults with isolated systolic hypertension: an ambulatory blood pressure monitoring-based study of real-world clinical patients

Sunwon Kim, Jong Seok Lee, Woohyeun Kim, Yong Hyun Kim, Jin Seok Kim, Sang Yup Lim, Seong Hwan Kim, Jeong Cheon Ahn, Chang Gyu Park, Woo Hyuk Song

Research output: Contribution to journalArticle

Abstract

The central hemodynamic characteristics of young adults with isolated systolic hypertension (ISH) remain controversial, particularly regarding the extent of pulse pressure amplification (PPamp) compared with that of normotensives (NTs). Given the lack of ambulatory blood pressure monitoring (ABPM)-based data, this study evaluated 509 untreated young adults (18–35 years) who had undergone ABPM during the last decade, 109 who had undergone both ABPM and SphygmoCor analysis, and 26 newly recruited NTs. The agreement rate between office BP- and ABPM-based subtype classification was alarmingly low (50.7%). ISH was distinguishable from systolic–diastolic hypertension, the predominant subtype characterized by increased central BPs and stiffened arteries. The central hemodynamic parameters were all similar between patients with ISH and white-coat hypertension (WC). ISH patients had central BPs that were, albeit higher than those of NTs, at an upper-normal level that was comparable to those of WC patients. ISH patients had similar cfPWV but significantly higher PPamp than NTs (p = 0.032). The central hemodynamic parameters of the participants were further analyzed according to central pressure waveform types (A vs. B vs. C). Type C waves were associated with the highest PPamp and lowest cfPWV, whereas type A waves were associated with the lowest PPamp and highest cfPWV. Subjects with type B waves, an intermediate form, also had considerably high PPamps. Waveform composition differed significantly across hypertension subtypes (p < 0.001). ISH patients mostly had type B or C waves (96.7%), with only 3.3% having type A waves. This study based on a refined diagnosis showed that the ambulatory ISH of young adults arises from highly elastic arteries and related robustness of PPamp and shares similar central hemodynamic characteristics with WC patients.

Original languageEnglish
JournalHypertension Research
DOIs
Publication statusAccepted/In press - 2019 Jan 1

Fingerprint

Ambulatory Blood Pressure Monitoring
Young Adult
Hemodynamics
Hypertension
White Coat Hypertension
Blood Pressure
Arteries
Pressure

Keywords

  • Ambulatory blood pressure monitoring
  • Central pressure waveform type
  • Isolated systolic hypertension of young adults
  • Pulse pressure amplification
  • White-coat hypertension

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Central hemodynamic characteristics of young adults with isolated systolic hypertension : an ambulatory blood pressure monitoring-based study of real-world clinical patients. / Kim, Sunwon; Lee, Jong Seok; Kim, Woohyeun; Kim, Yong Hyun; Kim, Jin Seok; Lim, Sang Yup; Kim, Seong Hwan; Ahn, Jeong Cheon; Park, Chang Gyu; Song, Woo Hyuk.

In: Hypertension Research, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "The central hemodynamic characteristics of young adults with isolated systolic hypertension (ISH) remain controversial, particularly regarding the extent of pulse pressure amplification (PPamp) compared with that of normotensives (NTs). Given the lack of ambulatory blood pressure monitoring (ABPM)-based data, this study evaluated 509 untreated young adults (18–35 years) who had undergone ABPM during the last decade, 109 who had undergone both ABPM and SphygmoCor analysis, and 26 newly recruited NTs. The agreement rate between office BP- and ABPM-based subtype classification was alarmingly low (50.7{\%}). ISH was distinguishable from systolic–diastolic hypertension, the predominant subtype characterized by increased central BPs and stiffened arteries. The central hemodynamic parameters were all similar between patients with ISH and white-coat hypertension (WC). ISH patients had central BPs that were, albeit higher than those of NTs, at an upper-normal level that was comparable to those of WC patients. ISH patients had similar cfPWV but significantly higher PPamp than NTs (p = 0.032). The central hemodynamic parameters of the participants were further analyzed according to central pressure waveform types (A vs. B vs. C). Type C waves were associated with the highest PPamp and lowest cfPWV, whereas type A waves were associated with the lowest PPamp and highest cfPWV. Subjects with type B waves, an intermediate form, also had considerably high PPamps. Waveform composition differed significantly across hypertension subtypes (p < 0.001). ISH patients mostly had type B or C waves (96.7{\%}), with only 3.3{\%} having type A waves. This study based on a refined diagnosis showed that the ambulatory ISH of young adults arises from highly elastic arteries and related robustness of PPamp and shares similar central hemodynamic characteristics with WC patients.",
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AU - Kim, Jin Seok

AU - Lim, Sang Yup

AU - Kim, Seong Hwan

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