Author + information
- Yuichiro Yano, MD, PhD,
- Stanley S. Franklin, MD,
- Philip Greenland, MD and
- Donald Lloyd-Jones, MD, ScM∗ ()
- ↵∗Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, Illinois 60611
We thank Dr. O’Rourke and colleagues for their interest in our findings. Their comments are primarily focused on how our findings can be translated into practice or policy. We urge caution when extrapolating epidemiological findings to clinical recommendations. Research findings, especially those from observational studies, need to be interpreted within the context of global evidence. Unfortunately, evidence is sparse pertaining to long-term outcomes in younger adults with isolated systolic hypertension (ISH). Considering the limited prognostic data on ISH at younger ages, which our data begin to address, we agree with the comment that it would be premature and difficult to conduct randomized intervention trials in a population of younger individuals who would be at low risk for events in the near term. We suggest that the next major step is to replicate our results in other studies with long-term follow-up of younger adults (1,2).
The letter also addresses precision (personalized) medicine. Execution of precision medicine in younger adults with ISH will (partly) resolve concerns regarding patient preference, unnecessary expense, and adverse effects associated with treatments (3). ISH in younger adults appears to be a heterogeneous condition; some have higher stroke volume, whereas others have higher aortic stiffness, or both (4). One size does not seem to fit all in the clinical management of ISH at younger ages. The optimal means to identify higher-risk groups among younger ISH patients merits further research. Clinical characteristics (e.g., body weight, diabetes), biomarkers (e.g., brain natriuretic peptide), and out-of-office blood pressure measurement (e.g., home or ambulatory monitoring) may serve to identify higher-risk individuals. Rather than treating ISH in younger adults as a monolithic disease and continuing to debate whether it is “pseudo” or “spurious” hypertension, detailed phenotyping of ISH patients based on (patho) physiology and global context of risk for cardiovascular events would seem to be most useful to assess an individual patient’s expected net benefit from therapy.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2015 American College of Cardiology Foundation