330
JACC VOL. 66, NO. 3, 2015
Letters
JULY 21, 2015:328–33
(3) if based solely on the brachial cuff measurement of systolic pressure without taking into account the shape of the pressure waveform in central and peripheral (i.e., brachial and/ or radial) arteries. We have pressed this view (4) on the European Society of Hypertension/European Society of Cardiology committee (Yano et al. [1] reference 6) on the basis that elevated brachial and radial systolic pressure in young persons (especially tall male subjects) is caused by an exaggerated narrow
4. O’Rourke MF, Adji A. Guidelines on guidelines: focus on isolated systolic hypertension in youth. J Hypertens 2013;31:649–54. 5. Gosain P. Navigating patient preference and guidelines as a fellow. J Am Coll Cardiol 2015;65:398–9.
REPLY: Interpreting Blood Pressure in Young Adults We thank Dr. O’Rourke and colleagues for their interest in our findings. Their comments are primarily focused on how our findings can be translated into
systolic pressure peak of the radial and brachial
practice or policy. We urge caution when extrapo-
pressure waves but a normal aortic pulse. This
lating epidemiological findings to clinical recom-
contrasts with elevated systolic pressure (i.e., ISH) in persons over age 60 years who almost invariably have a much broader systolic peak, which is similar in the aorta and upper limb arteries (Yano et al. [1] reference 41). On the basis of outcomes in the Chicago study, one would find it hard to justify a randomized study of therapy compared with placebo in ISH of adult male subjects 50% in 2 views. If the latter cut-off was to be
1. McCarron P, Smith GD, Okasha M, McEwen J. Blood pressure in young adulthood and mortality from cardiovascular disease. Lancet 2000;355: 1430–1. 2. Sundström J, Neovius M, Tynelius P, Rasmussen F. Association of blood pressure in late adolescence with subsequent mortality: cohort study of
applied to define multivessel disease, this could lead to a large number of procedures, if complete revascularization strategy was adopted, with an inevitable major impact on the PPCI service provi-
Swedish male conscripts. BMJ 2011;342:d643.
sion. Adenosine stress cardiac magnetic resonance 1
3. Collins FS, Varmus H. A new initiative on precision medicine. N Engl J Med 2015;372:793–5.
to 5 days after ST-segment elevation myocardial
4. McEniery CM, Yasmin, Wallace S, et al., for the ENIGMA Study Investigators. Increased stroke volume and aortic stiffness contribute to isolated systolic hypertension in young adults. Hypertension 2005;46:221–6.
infarction is safe and can allow accurate detection of significant nonculprit territory stenosis. A recent study by our group (5) demonstrated that
JACC VOL. 66, NO. 3, 2015
Letters
JULY 21, 2015:328–33
(3) if based solely on the brachial cuff measurement of systolic pressure without taking into account the shape of the pressure waveform in central and peripheral (i.e., brachial and/ or radial) arteries. We have pressed this view (4) on the European Society of Hypertension/European Society of Cardiology committee (Yano et al. [1] reference 6) on the basis that elevated brachial and radial systolic pressure in young persons (especially tall male subjects) is caused by an exaggerated narrow
4. O’Rourke MF, Adji A. Guidelines on guidelines: focus on isolated systolic hypertension in youth. J Hypertens 2013;31:649–54. 5. Gosain P. Navigating patient preference and guidelines as a fellow. J Am Coll Cardiol 2015;65:398–9.
REPLY: Interpreting Blood Pressure in Young Adults We thank Dr. O’Rourke and colleagues for their interest in our findings. Their comments are primarily focused on how our findings can be translated into
systolic pressure peak of the radial and brachial
practice or policy. We urge caution when extrapo-
pressure waves but a normal aortic pulse. This
lating epidemiological findings to clinical recom-
contrasts with elevated systolic pressure (i.e., ISH) in persons over age 60 years who almost invariably have a much broader systolic peak, which is similar in the aorta and upper limb arteries (Yano et al. [1] reference 41). On the basis of outcomes in the Chicago study, one would find it hard to justify a randomized study of therapy compared with placebo in ISH of adult male subjects 50% in 2 views. If the latter cut-off was to be
1. McCarron P, Smith GD, Okasha M, McEwen J. Blood pressure in young adulthood and mortality from cardiovascular disease. Lancet 2000;355: 1430–1. 2. Sundström J, Neovius M, Tynelius P, Rasmussen F. Association of blood pressure in late adolescence with subsequent mortality: cohort study of
applied to define multivessel disease, this could lead to a large number of procedures, if complete revascularization strategy was adopted, with an inevitable major impact on the PPCI service provi-
Swedish male conscripts. BMJ 2011;342:d643.
sion. Adenosine stress cardiac magnetic resonance 1
3. Collins FS, Varmus H. A new initiative on precision medicine. N Engl J Med 2015;372:793–5.
to 5 days after ST-segment elevation myocardial
4. McEniery CM, Yasmin, Wallace S, et al., for the ENIGMA Study Investigators. Increased stroke volume and aortic stiffness contribute to isolated systolic hypertension in young adults. Hypertension 2005;46:221–6.
infarction is safe and can allow accurate detection of significant nonculprit territory stenosis. A recent study by our group (5) demonstrated that
