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Identification of phenotypes at risk of transition from diastolic hypertension to isolated systolic hypertension

Journal of Human Hypertension volume 30, pages 392–396 (2016)Cite this article

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Abstract

Little is known about the potential progression of hypertensive patients towards isolated systolic hypertension (ISH) and about the phenotypes associated with the development of this condition. Aim of this study was to detect predictors of evolution towards ISH in patients with initial systolic–diastolic hypertension. We selected 7801 hypertensive patients free of prevalent cardiovascular (CV) diseases or severe chronic kidney disease and with at least 6-month follow-up from the Campania Salute Network. During 55±44 months of follow-up, incidence of ISH was 21%. Patients with ISH at the follow-up were significantly older (P<0.0001), had longer duration of hypertension, higher prevalence of diabetes and were more likely to be women (all P<0.0001). They exhibited higher baseline left ventricular mass index (LVMi), arterial stiffness (pulse pressure/stroke index), relative wall thickness (RWT) and carotid intima-media thickness (IMT; all P<0.001). Independent predictors of incident ISH were older age (odds ratio (OR)=1.14/5 years), female gender (OR=1.30), higher baseline systolic blood pressure (OR=1.03/5 mm Hg), lower diastolic blood pressure (OR=0.89/5 mm Hg), longer duration of hypertension (OR=1.08/5 months), higher LVMi (OR=1.02/5 g m−2.7), arterial stiffness (OR=2.01), RWT (OR=1.02), IMT (OR=1.19 mm−1; all P<0.0001), independently of antihypertensive treatment, obesity, diabetes and fasting glucose (P>0.05). Our findings suggest that ISH is a sign of aggravation of the atherosclerotic disease already evident by the target organ damage. Great efforts should be paid to prevent this evolution and prompt aggressive therapy for arterial hypertension should be issued before the onset of target organ damage, to reduce global CV risk.

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Acknowledgements

The authors are indebted to the nurses Stanislao Marigliano, Giuseppe Napolitano, Francesco Scarici, Antonio Scognamiglio and Ester Maria Tessitore for their invaluable support in the patients’ management, and to their coordinator Anna Vitiello.

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  1. R Esposito and R Izzo: These authors contributed equally to this work.

Authors and Affiliations

  1. Hypertension Research Center (CIRIAPA), Federico II University Hospital, Naples, Italy

    R Esposito, R Izzo, M Galderisi, M De Marco, E Stabile, G Esposito, V Trimarco, F Rozza, N De Luca & G de Simone

  2. Department of Translational Medical Science, Federico II University Hospital, Naples, Italy

    R Esposito, R Izzo, M Galderisi, M De Marco, F Rozza, N De Luca & G de Simone

  3. Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy

    E Stabile & G Esposito

  4. Department of Neurosciences, Federico II University Hospital, Naples, Italy

    V Trimarco

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  1. R Esposito
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  2. R Izzo
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  3. M Galderisi
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  4. M De Marco
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  6. G Esposito
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  8. F Rozza
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  9. N De Luca
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Correspondence to G de Simone.

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Esposito, R., Izzo, R., Galderisi, M. et al. Identification of phenotypes at risk of transition from diastolic hypertension to isolated systolic hypertension. J Hum Hypertens 30, 392–396 (2016). https://doi.org/10.1038/jhh.2015.91

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