title: Natural history of hypertension subtypes in young and middle-age adults.
abstract: BACKGROUND
  The evolution of hypertension (HT) subtypes in young-to-middle-age subjects is unclear.
  
  
  METHODS
  We did a prospective study in 1,141 participants aged 18-45 years from the HARVEST study screened for stage 1 HT, and 101 nonhypertensive subjects of control during a median follow-up of 72.9 months.
  
  
  RESULTS
  At baseline, 13.8% of the subjects were classified as having isolated systolic HT (ISH), 24.8% as having isolated diastolic HT (IDH), and 61.4% as having systolic-diastolic HT (SDH). All hypertensive groups developed sustained HT (clinic blood pressure > or =140/90 mm Hg from two consecutive visits occurring at least after > or =6 months of observation) more frequently than nonhypertensive subjects (P < 0.001 for all) with adjusted odds ratio of 5.2 (95%CI 2.9-9.2) among the SDH subjects, 2.6 (95%CI 1.5-4.5) among the IDH subjects, and 2.2 (95%CI 1.2-4.5) among the ISH subjects. When the definition of HT was based on ambulatory blood pressure (mean daytime blood pressure > or =135/85 mm Hg, n = 798), odds ratios were 5.1 (95%CI 3.1-8.2), 5.6 (95%CI 3.2-9.8), and 3.3 (95%CI 1.7-6.3), respectively. In the fully adjusted logistic model, the risk of ambulatory HT was smaller for the ISH than the IDH (P = 0.049) or SDH (P = 0.053) individuals.
  
  
  CONCLUSIONS
  The present results indicate that young-to-middle-age subjects with ISH have a smaller risk of developing ambulatory HT than either subjects with SDH or IDH. Whether antihypertensive treatment can be postponed for long periods of time in young subjects with mild elevations of clinic systolic BP and low global cardiovascular risk should be examined in further studies.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Saladini
authors.forename: Francesca
authors.initials: F
authors.lastname: Dorigatti
authors.forename: Massimo
authors.initials: M
authors.lastname: Santonastaso
authors.forename: Lucio
authors.initials: L
authors.lastname: Mos
authors.forename: Fabio
authors.initials: F
authors.lastname: Ragazzo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bortolazzi
authors.forename: Mauro
authors.initials: M
authors.lastname: Mattarei
authors.forename: Guido
authors.initials: G
authors.lastname: Garavelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Mormino
authors.forename: Paolo
authors.initials: P
authors.lastname: Palatini
mesh_terms: D000328:Adult; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D055815:Young Adult