The Association Between Isolated Central Systolic Hypertension and Target Organ Damage

Abstract

Isolated systolic hypertension (ISH) is a well-known hypertension subtype that is mainly found in older individuals. It has been shown to be associated with target organ damage including arterial stiffness and left ventricular hypertrophy. On the other hand, there is no available data on isolated central systolic hypertension. It is not clear whether this hypertension phenotype exists or not. If it exists, is it associated with any target organ damage? Therefore, the aim of this study was to determine whether isolated central systolic hypertension is an existing hypertension subtype, and whether this clinical entity requires intervention, or it is just benign. In this cross-sectional study we recruited 1216 individuals of African ancestry who were (≥18 years) and categorized into five groups based on blood pressure profiles: normotensive (NT), isolated central systolic hypertension (ICSH), isolated brachial systolic hypertension (IBSH), isolated central and brachial systolic hypertension (ICBSH), and hypertensive (HT). Clinical and demographic data were collected using standardized questionnaires at the University of the Witwatersrand, Johannesburg, South Africa, with ethical approval (MED24-02-475). Anthropometric assessments, conventional and central blood pressure measurements, pulse wave velocity (PWV), and echocardiographic left ventricular mass index (LVMI) were obtained. Additionally, 24-hour ambulatory blood pressure monitoring was used to assess blood pressure throughout the whole day. Statistical analyses, including multivariate-adjusted linear regression models, were performed using SAS 9.4, adjusting for confounders such as age, sex, alcohol consumption, tobacco use, and diabetes. Our results show that the prevalence of people with both central and peripheral hypertension in this population is 27.6%. When we categorised these hypertensives according to isolated systolic hypertension status, the prevalence was 5.9%, 6.7%, 18.9% and 68.5% for IBSH, ICSH, ICBSH and HT respectively. The PWV of ICSH was significantly higher than that of the normotensives but it was similar to IBSH, but the LVMI of ICSH was significantly higher than that of IBSH. These results show that ICSH is a clinical entity that requires intervention since it increases arterial stiffness similar to IBSH. Most importantly its negative impact on the left ventricle is worse than that of IBSH.