Hypertension is a common and complicated condition that is a major cause of cardiovascular diseases and early death worldwide. About 30% of adults around the globe have high blood pressure. The likelihood of developing hypertension increases with age. In younger people, men are more likely to have it than women, but this changes after age 65 when it becomes more common in women. It’s generally defined as having a systolic blood pressure above 130 mmHg and/or a diastolic blood pressure above 80 mmHg [1].
What is Isolated Systolic Hypertension?
Isolated systolic hypertension (ISH) is a type of Hypertension where the systolic blood pressure is above 140 mmHg, but diastolic blood pressure is below 90 mmHg. ISH is the most common form of high blood pressure in both young and elderly people [2].
Isolated Systolic Hypertension in Young People (ISHY)
The question of whether isolated systolic hypertension in youth (ISHY) requires treatment is controversial. Some scientists argue that immediate treatment is required because ISHY often accompanies other risk factors like obesity and smoking and may lead to early stiffening of the aorta due to increased blood flow. However, not everyone with ISHY has these risk factors. Others believe ISHY isn’t a major concern, especially in tall, active, non-smoking individuals, as the high blood pressure is linked to their very flexible arteries. In summary, some studies suggest that young men with ISHY don’t have higher overall health risks compared to those with normal blood pressure, as the ISHY group typically has normal central blood pressure [3].
Isolated Systolic Hypertension in Elderly People
Interestingly, 70% of elderly individuals with hypertension also have symptoms of isolated systolic hypertension (ISH). This condition in older adults is thought to result from arterial stiffness that occurs with aging. Studies show that in cases of isolated systolic hypertension, high pulse pressure (more than 40 mmHg for brachial pulse pressure and more than 50 mmHg for aortic pulse pressure) is a stronger predictor of heart attacks, heart failure, strokes, and cardiovascular death [4].
The importance of pulse wave analysis measurement in ISH cases
As mentioned earlier, isolated systolic hypertension (ISH) should be evaluated differently for young people and the elderly. For young and middle-aged individuals with ISH, if their central systolic blood pressure (SBPao) is low, they might have a lower risk of needing treatment compared to those with high central SBP. Therefore, measuring central blood pressure and its changes is very important for this group [5].
In contrast, for elderly individuals, ISH is often caused by stiffening arteries [6]. In this case, measuring arterial stiffness, such as with Pulse Wave Velocity or Pulse Wave Analysis measurements, can give doctors a clearer view of the cardiovascular system. Tools like the Arteriograph, which provides both pulse wave analysis and pulse wave velocity measurements, are useful for assessing ISH.