Hypertension Criteria and the Early Detection of Vascular Aging in Youth.

Introduction: Hypertension is a leading risk factor of global morbidity and mortality. Reports indicate a rise in mortality linked to blood pressure (BP) levels exceeding 115/75 mmHg. Even with hypertension management based on redefined guidelines, many young individuals with early signs of target organ injury (TOI) may still go undetected AIM : We determined the most accurate diagnostic criteria of hypertension (using the 2017 ACC/AHA and the 2023 ESC/ESH guidelines) for detecting an increased risk of early vascular aging (EVA). We additionally estimated the effects of the guidelines' definitions on the distribution of BP phenotypes and risk of EVA.

Methods: A total of 1026 men and women (aged 20-30 years) were included. The primary data collected included office- and ambulatory blood pressure (ABPM) measurement, and carotid-femoral pulse wave velocity (PWV). The upper 25th percentile of PWV was regarded as having an increased risk of EVA. The frequencies of hypertension and BP phenotypes were calculated according to both guidelines and correlated with TOI by multiple linear regression. Receiver operating characteristic (ROC) curves were constructed to determine the best BP threshold for detecting increased risk of EVA.

Results: Pulse wave velocity was associated with all pathological BP phenotypes (SHT, WCHT and MHT), based on the ESC/ESH and with SHT and WCHT based on the ACC/AHA criteria (all p<0.024).

Conclusion: The ESC/ESH criteria, but not the ACC/AHA criteria, is sensitive to identify all BP phenotypes. The lower thresholds advised by the ACC/AHA guidelines however seem to favour early detection of increased risk for EVA.