Saladini Francesca, Palatini Paolo
Department of Medicine, University of Padova, via Giustiniani, 2, 35128, Padua, Italy.
High Blood Press Cardiovasc Prev. 2017 Jun;24(2):133-139. doi: 10.1007/s40292-017-0199-y. Epub 2017 Apr 3.
Isolated systolic hypertension (ISH) is the most common form of hypertension in older persons and its predictive value for adverse outcome is well known. However, ISH can be frequently found also in young individuals, especially among males, but its prognostic significance in this setting is still controversial. Increased large artery stiffness is the main determinant of ISH in elderly patients whereas the mechanisms that lead to ISH in the young are still debated. According to some authors ISH in youth is a totally benign condition that can be called "spurious hypertension" a phenomenon due to enhanced pulse pressure amplification of the pulse wave from central to peripheral sites. According to others the main determinant of ISH in young individuals is increased sympathetic activity and the consequent hyperkinetic state characterized by elevated heart rate and stroke volume. This phenomenon is often amplified by a powerful alarm reaction to the medical visit. However, recent research has shown that ISH in the young is a heterogeneous condition and that in some individuals also increased arterial stiffness can play a role. Although ISH seems to be a benign condition chiefly in young men, only few longitudinal data assessing the association with adverse outcomes are available. Future studies with long term follow-up are needed to better understand the clinical significance of this condition.
单纯收缩期高血压（ISH）是老年人中最常见的高血压形式，其对不良结局的预测价值是众所周知的。然而，ISH在年轻人中也很常见，尤其是男性，但在这种情况下其预后意义仍存在争议。大动脉僵硬度增加是老年患者ISH的主要决定因素，而导致年轻人ISH的机制仍存在争议。一些作者认为，年轻人的ISH是一种完全良性的状况，可称为“假性高血压”，这是一种由于脉搏波从中心到外周部位的脉压放大增强而出现的现象。另一些人则认为，年轻人ISH的主要决定因素是交感神经活动增加以及随之而来的以心率和心输出量升高为特征的高动力状态。这种现象通常会因对就诊的强烈警觉反应而加剧。然而，最近的研究表明，年轻人的ISH是一种异质性状况，在一些个体中，动脉僵硬度增加也可能起作用。尽管ISH似乎主要是年轻人中的一种良性状况，但评估其与不良结局关联的纵向数据很少。需要进行长期随访的未来研究，以更好地了解这种状况的临床意义。
