Spurious systolic hypertension of youth: fit young men with elastic arteries

Background We examined the role of high pulse pressure (PP) amplification in spurious systolic hypertension (SSH). Methods We recorded demographic characteristics, brachial blood pressure (BP) (Omron Model HEM-705 CP, Vernon Hills, IL), aortic BP, and arterial wave reflection (Sphygmocor, AtCor Medical, version 6.2, NSW, Australia) and PP amplification in 174 healthy medical students (87 male) and 22 young male hypertensive subjects. Results Eleven subjects had SSH (147 ±2 v control 114 ±1 mm Hg, mean ± SEM,), normal aortic and brachial diastolic BP with an aortic pressure waveform that was normal in contour and amplitude. All were male, tall, nonsmokers, and active in sports, with slower heart rate, reduced arterial wave reflection (−8 ± 3 v −0.7 ±1) and enhanced PP amplification (31 ±1 v 18 ±1 mm Hg, P< .01. In contrast, male hypertensive subjects had reduced amplification (14 ±0.9 mm Hg) and enhanced arterial wave reflection (17 ±1.9). Conclusions The SSH of youth, with raised brachial but normal aortic systolic BP, is commonly seen in tall men who are active in sports and are nonsmokers. It may be explained by the exaggerated first systolic peak in the brachial artery pressure waveform, which is due to very high PP amplification and low arterial wave reflection due to elastic arteries.