Novel hypertension phenotypes based on cross-classification of 24-h brachial and aortic SBP

BACKGROUND: Novel hypertension phenotypes are described by cross-classification of brachial and aortic SBP (brSBP/aoSBP). OBJECTIVES: The aim of this study is to examine their prevalence and age and sex-distribution, factors that potentially modulate them, and their association with left ventricular hypertrophy (LVH). METHODS: Data on 24-h ambulatory BP monitoring (ABPM) using the Mobilograph device (IEM GmbH, Stolberg, Germany) and LVH from the International 24-h Ambulatory aortic Blood pressure Consortium (i24ABC) were retrieved from 31 centers (17 countries). The population was categorized into four phenotypes; concordant systolic normotension (CSN: both SBPs normal), isolated brachial systolic hypertension (IbrSH: high brSBP/normal aoSBP), isolated aortic systolic hypertension (IaoSH: normal brSBP/high aoSBP), and concordant systolic hypertension (CSH: both SBPs high). RESULTS: In 8738 participants (age: 58.4 ± 15.1 years; 51.8% men), the prevalence of IaoSH was 7.7%, being more prevalent in men, and presenting a U-shape age-distribution in them compared to a linear distribution in females. IaoSH was associated with lower heart rate and beta-blockade medications. The prevalence of IbrSH was 6.5%, presenting an inverted U-shape age-distribution; it was higher in the presence of higher heart rate and calcium channel-blockade. In 2307 individuals with LVH data, after adjustment for age, sex, DBP, IaoSH - but not IbrSH - had 2.6 higher odds of LVH compared to CSN (95% confidence interval, 1.7-3.9) and similar to CSH. CONCLUSION: IaoSH and IbrSH amounted to almost 15% and showed specific clinic characteristics. Only IaoSH was significantly associated with LVH. Outcome-driven randomized controlled trials are needed to further investigate their clinical relevance.

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Journal
Journal of Hypertension
Published
2026-06-16
DOI
https://doi.org/10.1097/hjh.0000000000004376
Primary Topic
Cardiovascular Health and Disease Prevention
Type
article
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article

Novel hypertension phenotypes based on cross-classification of 24-h brachial and aortic SBP

Auxiliadora Graciani, Dimitrios Terentes Printzios, Ian B. Wilkinson, Andréa Araújo Brandão et al.
Journal of Hypertension
Cardiovascular Health and Disease Prevention
article

Novel hypertension phenotypes based on cross-classification of 24-h brachial and aortic SBP

Auxiliadora Graciani, Dimitrios Terentes Printzios, Ian B. Wilkinson, Andréa Araújo Brandão, A B Schutte, P Fitscha, Gary L. Pierce, Anna Paini, Barry J. McDonnell, Fotios Karachalias, Carmel M. McEniery, Kathrin Danninger, Mohsen Agharazii, G Stergiou, Elpida Athanasopoulou, Bernd Reininghaus, James E. Sharman, JR Banegas, Sabine Perl, Siegfried Wassertheurer, Bernhard Hametner, A L Paiva, Lisa J. Ware, Marco Antônio Mota-Gomes, Christopher C. Mayer, C Giannattasio, Enrique Rodilla Sala, Petros P. Sfikakis, Janos Nemcsik, ANTONIOS LAZARIDIS, Sola Aoun Bahous, Daniel Piskorz, Charalambos Vlachopoulos, Alejandro de la Sierra, Maria Lorenza Muiesan, Thomas Weber, Jacques Blacher, Antonios Argyris, Yan Li, Yi Zhang, Alessandro Maloberti, Anastasios Kollias, Piotr Jankowski, Giacomo Pucci, Kazuomi Kario, Ronald K. Binder, Eva Reininghaus, Athanase D. Protogerou, Eugenia Gkaliagkousi
article en

Abstract

BACKGROUND: Novel hypertension phenotypes are described by cross-classification of brachial and aortic SBP (brSBP/aoSBP). OBJECTIVES: The aim of this study is to examine their prevalence and age and sex-distribution, factors that potentially modulate them, and their association with left ventricular hypertrophy (LVH). METHODS: Data on 24-h ambulatory BP monitoring (ABPM) using the Mobilograph device (IEM GmbH, Stolberg, Germany) and LVH from the International 24-h Ambulatory aortic Blood pressure Consortium (i24ABC) were retrieved from 31 centers (17 countries). The population was categorized into four phenotypes; concordant systolic normotension (CSN: both SBPs normal), isolated brachial systolic hypertension (IbrSH: high brSBP/normal aoSBP), isolated aortic systolic hypertension (IaoSH: normal brSBP/high aoSBP), and concordant systolic hypertension (CSH: both SBPs high). RESULTS: In 8738 participants (age: 58.4 ± 15.1 years; 51.8% men), the prevalence of IaoSH was 7.7%, being more prevalent in men, and presenting a U-shape age-distribution in them compared to a linear distribution in females. IaoSH was associated with lower heart rate and beta-blockade medications. The prevalence of IbrSH was 6.5%, presenting an inverted U-shape age-distribution; it was higher in the presence of higher heart rate and calcium channel-blockade. In 2307 individuals with LVH data, after adjustment for age, sex, DBP, IaoSH - but not IbrSH - had 2.6 higher odds of LVH compared to CSN (95% confidence interval, 1.7-3.9) and similar to CSH. CONCLUSION: IaoSH and IbrSH amounted to almost 15% and showed specific clinic characteristics. Only IaoSH was significantly associated with LVH. Outcome-driven randomized controlled trials are needed to further investigate their clinical relevance.

Journal of Hypertension
Semmelweis University (HU), South African Medical Research Council (ZA), Tongji University (CN), University of Iowa (US), University of Tasmania (AU), AIT Austrian Institute of Technology GmbH (AT), Statistics Austria (AT), Jichi Medical University (JP), University of the Witwatersrand (ZA), National and Kapodistrian University of Athens (GR), Medical University of Graz (AT), Université Paris Cité (FR), Aristotle University of Thessaloniki (GR), University of Perugia (IT), North-West University (ZA), Universidad Cardenal Herrera CEU (ES), Ruijin Hospital (CN), UNSW Sydney (AU), Universidade do Estado do Rio de Janeiro (BR), Centre hospitalier universitaire de Québec (CA), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), University Hospital Mútua de Terrassa (ES), Assistance Publique – Hôpitaux de Paris (FR), Papageorgiou General Hospital (GR), The George Institute for Global Health (AU), Laiko General Hospital of Athens (GR), Hôtel-Dieu de Québec (CA), Klinikum Wels-Grieskirchen (AT), Shanghai Institute of Hypertension (CN), Shanghai Tenth People's Hospital (CN), Hôtel-Dieu de Paris (FR), Postgraduate School of Molecular Medicine (PL), Centro Universitário Cesmac (BR), Hospital Británico de Buenos Aires (AR), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES), Addenbrooke's Hospital (GB), Sotiria General Hospital (GR), Université Laval (CA), Lebanese American University (LB), Universidad Autónoma de Madrid (ES), University of Milano-Bicocca (IT), University of Brescia (IT), Cardiff Metropolitan University (GB)
Openalex Percentile: Top 8%
Cardiovascular Health and Disease Prevention
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