Author + information
- Michael F. O’Rourke, MD DSc∗ (, )
- Audrey Adji, Mb MBiomedE and
- Mayooran Namasivayam, MBBS(Hons), BSc(Med)Hons
- ↵∗Suite 810, St. Vincent’s Clinic, 438 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia
The remarkable paper from the Chicago Heart Association Detection Project in Industry Study (1) studied cardiovascular mortality (3,119 deaths) over 31 years in 27,081 initially well persons, according to initial categorizations of systolic and diastolic hypertension, isolated diastolic hypertension, isolated systolic hypertension (ISH), high-normal blood pressure (BP), and optimal-normal BP. The results validate recent concerns that results of treating elderly persons (>60 years) cannot be applied universally to younger persons, as in the 18- to 49-year age group described here (2).
The Central Illustration in Yano et al. (1) shows, for male subjects, little or no deviation in outcome up to 20 years compared with high-normal BP or optimal-normal BP, but considerable deviation from the other 2 hypertensive groups. We have argued that ISH in young male subjects may be “spurious” (3) if based solely on the brachial cuff measurement of systolic pressure without taking into account the shape of the pressure waveform in central and peripheral (i.e., brachial and/ or radial) arteries. We have pressed this view (4) on the European Society of Hypertension/European Society of Cardiology committee (Yano et al.  reference 6) on the basis that elevated brachial and radial systolic pressure in young persons (especially tall male subjects) is caused by an exaggerated narrow systolic pressure peak of the radial and brachial pressure waves but a normal aortic pulse. This contrasts with elevated systolic pressure (i.e., ISH) in persons over age 60 years who almost invariably have a much broader systolic peak, which is similar in the aorta and upper limb arteries (Yano et al.  reference 41).
On the basis of outcomes in the Chicago study, one would find it hard to justify a randomized study of therapy compared with placebo in ISH of adult male subjects <50 years of age. Another important factor in guidelines, addressed by a cardiology fellow in the same issue of the journal (5) is “patient preference.” For the trivial difference in outcome at 20 years, would not most male subjects wish to defer the stigma of disease, the expense, the inconvenience, and side effects of treatment for another year or 2 until issues are clarified? How are young fellows (5) expected to include opinions, guidelines, and patient preference in their discussions with patients <50 years of age with ISH?
Please note: Dr. O’Rourke is a founding director of both AtCor Medical P/L and Aortic Wrap P/L. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2015 American College of Cardiology Foundation
- Yano Y.,
- Stamler J.,
- Garside D.B.,
- et al.
- Gosain P.