ELEVATED PULSE PRESSURE IN HYPERTENSION OF THE YOUNG: DIFFERENT PATHOGENETIC BACKGROUND IN MEN AND WOMEN

Objective: The prognostic significance of elevated pulse pressure (PP) in the young is still a matter for debate. Previous studies suggest that high PP carries an increased risk of cardiovascular disease in women but not in men. We aimed to identify clinical, metabolic and haemodynamic characteristics associated with raised PP in young hypertensive adults and to investigate whether these associations differed according to gender. Design and method: We investigated 1207 young stage I hypertensives (878 males) from the HARVEST Study. Mean age was 33.1 ± 8.5 years and blood pressure (BP) 145.5 ± 10.6/93.5 ± 5.7 mmHg. For the analysis patients were divided into PP tertiles. All comparisons between males and females were tested with two-way ANCOVA using PP and sex as predictors, adjusting for age Results: Echocardiographic stroke volume was higher in men than women (82.1 ± 15.7 ml vs 70.8 ± 16.4 ml, p < 0.001). No between-sex difference was found for peripheral resistance. Twenty-four-hour urinary norepinephrine/creatinine was higher in women than men (68.2 ± 59.6 vs 54.4 ± 66.5 mcg/mg, p = 0.023) whereas no difference was found for epinephrine. PP was 52.8 ± 11.4 mmHg in men and 49.4 ± 9.4 mmHg in women (p < 0.001). Men in the top PP tertile were younger and had lower BMI than those in the bottom tertile (p < 0.001 and p = 0.002), while the opposite trend was found for women (p < 0.001 and p = 0.002; p for PP-sex interaction < 0.001 for both). Heart rate and systolic white coat effect progressively increased across PP tertiles in both genders (p < 0.001 for both). Glucose and triglycerides increased with increasing PP among women while the opposite was found for men, with a significant trend for glucose (p = 0.025). At the end of follow-up (mean 7.9 years) females in the top PP tertile presented higher systolic BP (p = 0.004), diastolic BP (p = 0.071) and heart rate (<0.001), compared to males of the corresponding tertile. Conclusions: Young hypertensive women are characterized by increased sympathetic activity whereas men show a hyperkinetic state. High PP is associated with greater BMI and worse metabolic profile in women, and with better metabolic data in men. This different pathogenetic background may account for the worse prognosis of isolated systolic hypertension in women compared to men.