24-hour isolated aortic systolic hypertension phenotype and its association with carotid and cardiac damage: the SAFAR study.

The prevalence of systolic hypertension phenotypes based on simultaneous 24-h brachial (br) and aortic (ao) ambulatory blood pressure monitoring (ABPM) remains unknown. We sought to describe their prevalence and associations with hypertension mediated organ damage (HMOD). Participants with 24-h br and ao ABPM, carotid ultrasound and echocardiography data were categorized into 4 systolic hypertension phenotypes: sustained systolic br and ao normotension (SSN), isolated br systolic hypertension (IbrSH), isolated ao systolic hypertension (IaoSH) and sustained br and ao systolic hypertension (SSH). Different calibrations for peripheral waveforms and cut-offs for 24-h ao systolic pressure were applied. Out of 1024 participants with ABPM, 684 had carotid and 423 echocardiography data. IaoSH ranged from 3.7% to 23.0% of the population, depending on the calibration and the applied cut-off; (SSN: 37.0-56.3%, IbrSH: 0.6-9.5%, SSH: 30.5-39.4%). In adjusted models including diastolic pressure, in comparison with SSN and IbrSH, IaoSH phenotype by 90 percentile of normalcy for calibration 2 (mean/diastolic pressure) had significantly higher carotid intimal-medial thickness, carotid cross-sectional area and left ventricular mass; the odds ratio (95% confidence intervals) of IaoSH for carotid hypertrophy and left ventricular hypertrophy was 2.57 (1.01-6.56) and 3.29 (1.13-9.55), respectively. Individuals with 24-h IaoSH and IbrSH constitute a non-neglectable percentage (around 10%) of the population. IaoSH cannot be detected by brachial ABPM due to the per se normal 24-h br systolic pressure and it is associated with increased HMOD, possibly leading to increased cardiovascular risk. Further outcome and mortality studies are needed to verify these results.