Cseh Domonkos, McDonnell Barry J, Mäki-Petäjä Kaisa M, Simonian Taylor, Cockcroft John R, Wilkinson Ian B, McEniery Carmel M
Division of Experimental Medicine and Immunotherapeutics, Department of Medicine University of Cambridge Cambridge UK.
Centre for Cardiovascular Research, Innovation and Development Cardiff Metropolitan University Cardiff UK.
J Am Heart Assoc. 2025 Sep 2;14(17):e042096. doi: 10.1161/JAHA.125.042096. Epub 2025 Aug 29.
Essential hypertension is often treated as a uniform condition. However, it encompasses distinct patterns of blood pressure elevation such as isolated systolic, systolic diastolic, and isolated diastolic hypertension, which vary in prevalence according to age and sex. We hypothesized that different hemodynamic mechanisms account for the age- and sex-related differences in these hypertensive phenotypes.
In this cross-sectional analysis of the ACCT (Anglo-Cardiff Collaborative Trial), 5371 individuals (2402 male), aged 18 to 92 years, free of cardiovascular disease and medication were included. Blood pressure, cardiac output, stroke volume, peripheral vascular resistance (PVR), and aortic pulse wave velocity were measured. Within each sex, subjects were stratified according to age (<30, 30-60, and >60 years), and blood pressure phenotype based on clinic (seated) blood pressure.
Isolated systolic hypertension was the most common hypertensive phenotype in young men and characterized by an elevated cardiac output and stroke volume. In contrast, systolic diastolic hypertension and isolated diastolic hypertension were more common in younger females, with systolic diastolic hypertension associated with elevated PVR and aortic pulse wave velocity, and isolated diastolic hypertension with increased PVR. Systolic diastolic hypertension was the most common phenotype in middle age and accompanied by increased PVR in both sexes. Isolated systolic hypertension was again the most common phenotype in older individuals. However, in contrast to younger adults, isolated systolic hypertension affected both men and women equally (~1:1) and was characterized by elevated aortic pulse wave velocity and PVR.
Different hypertensive phenotypes are characterized by distinct hemodynamic mechanisms in an age- and sex-dependent manner. Targeting therapy toward primary hemodynamic abnormalities could lead to more effective interventions in essential hypertension.
原发性高血压通常被视为一种统一的病症。然而，它包含不同的血压升高模式，如单纯收缩期高血压、收缩期舒张期高血压和单纯舒张期高血压，其患病率随年龄和性别而有所不同。我们推测，不同的血流动力学机制导致了这些高血压表型在年龄和性别上的差异。
在这项对ACCT（英-加的夫协作试验）的横断面分析中，纳入了5371名年龄在18至92岁之间、无心血管疾病且未服用药物的个体（2402名男性）。测量了血压、心输出量、每搏输出量、外周血管阻力（PVR）和主动脉脉搏波速度。在每个性别中，根据年龄（<30岁、30至60岁和>60岁）以及基于诊室（坐位）血压的血压表型对受试者进行分层。
单纯收缩期高血压是年轻男性中最常见的高血压表型，其特征是心输出量和每搏输出量升高。相比之下，收缩期舒张期高血压和单纯舒张期高血压在年轻女性中更为常见，收缩期舒张期高血压与PVR和主动脉脉搏波速度升高相关，单纯舒张期高血压与PVR增加相关。收缩期舒张期高血压是中年人群中最常见的表型，且在两性中均伴有PVR升高。单纯收缩期高血压再次成为老年个体中最常见的表型。然而，与年轻人不同的是，单纯收缩期高血压对男性和女性的影响相同（约1:1），其特征是主动脉脉搏波速度和PVR升高。
不同的高血压表型以年龄和性别依赖性的方式具有不同的血流动力学机制。针对主要血流动力学异常进行治疗可能会在原发性高血压中带来更有效的干预措施。
