Pseudo hypertension of youth: too much of a good thing?

Extract

Since the advent of the modern mercury sphygmomanometer at the turn of the twentieth century, many epidemiological studies have demonstrated a clear relationship between blood pressure (BP) and cardiovascular risk. What is also clear is that, in almost all societies worldwide, BP increases with age. However, whereas systolic BP increases throughout life, diastolic BP rises until middle age, then plateaus, and actually falls after the age of 55 to 60 years. Thus, pulse pressure, the difference between systolic and diastolic BP, widens with age, and accounts for the high prevalence of isolated systolic hypertension in later life; rising from <5% in individuals <40 years old to >50% in the those >70 years. The underlying pathophysiology of such age-related changes in BP appears to be fatigue fracture of the elastic elements in the walls of the large arteries, which normally function to buffer the cyclical changes in pressure resulting from intermittent ventricular ejection. Stiffer arteries means a higher pulse pressure, as noted nearly 80 years ago by Bramwell and Hill,¹ who were also among the first to demonstrate an increase in aortic stiffness with age.