Isolated Systolic Hypertension in Young Adults: a Narrative Review of Epidemiology, Pathophysiology and Clinical Management
DOI:
https://doi.org/10.12775/JEHS.2026.88.69436Keywords
isolated systolic hypertension, young adults, cardiovascular risk, physiopathology, treatmentAbstract
Background: Isolated systolic hypertension in young adults is a problem of rising importance. Although it has been considered a benign condition caused by a hemodynamic phenomenon in a specific patient group, current population-based studies challenge this view. These data suggest increased cardiovascular risk and possible progression to sustained hypertension.
Aim: The aim of this narrative review is to summarize current evidence on isolated systolic hypertension in young adults and to compare recent findings with previous studies and the concept of spurious systolic hypertension.
Materials and methods: A systematic literature search using PubMed and Google Scholar online databases was conducted. Authors included and analyzed 30 studies published between 2000 and 2025 focusing on epidemiology, pathophysiology, hypertension progression, cardiovascular risk and therapeutic management of isolated systolic hypertension.
Results: The prevalence of isolated systolic hypertension appears to be increasing, affecting a considerable proportion of the young adults population, especially men. Hemodynamic findings suggest heterogeneity of pathophysiological mechanisms underlying this condition, including high arterial pulse pressure amplification, elevated stroke volume and aortic stiffness. Evidence indicates possible progression to sustained hypertension and increased cardiovascular disease and mortality risk. Data regarding therapeutic management is limited with current guidelines recommending a non-pharmacological approach.
Conclusions: Isolated systolic hypertension in young adults is a heterogeneous condition requiring further research to optimize its clinical management.
References
1. Mancia, G., Kreutz, R., Brunström, M., Burnier, M., Grassi, G., Januszewicz, A., Muiesan, M. L., Tsioufis, K., Agabiti-Rosei, E., Algharably, E. A. E., Azizi, M., Benetos, A., Borghi, C., Hitij, J. B., Cifkova, R., Coca, A., Cornelissen, V., Cruickshank, J. K., Cunha, P. G., … Kjeldsen, S. E. (2023). 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). Journal of Hypertension, 41(12), 1874–2071. https://doi.org/10.1097/HJH.0000000000003480
2. McEvoy, J. W., McCarthy, C. P., Bruno, R. M., Brouwers, S., Canavan, M. D., Ceconi, C., Christodorescu, R. M., Daskalopoulou, S. S., Ferro, C. J., Gerdts, E., Hanssen, H., Harris, J., Lauder, L., McManus, R. J., Molloy, G. J., Rahimi, K., Regitz-Zagrosek, V., Rossi, G. P., Sandset, E. C., … ESC Scientific Document Group. (2024). 2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) and endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO). European Heart Journal, 45(38), 3912–4018. https://doi.org/10.1093/eurheartj/ehae178
3. Cseh, D., Yasmin, McDonnell, B. J., Mäki‐Petäjä, K. M., Simonian, T., Cockcroft, J. R., Wilkinson, I. B., & McEniery, C. M. (2025). Phenotypes of Hypertension: Impact of Age and Sex on Hemodynamic Mechanisms. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 14(17), e042096. https://doi.org/10.1161/JAHA.125.042096
4. Rietz, H., Pennlert, J., Nordström, P., & Brunström, M. (2022). Prevalence, time-trends and clinical characteristics of hypertension in young adults: Nationwide cross-sectional study of 1.7 million Swedish 18-year-olds, 1969–2010. Journal of Hypertension, 40(6), 1231. https://doi.org/10.1097/HJH.0000000000003141
5. Eeftinck Schattenkerk, D. W., Van Gorp, J., Vogt, L., Peters, R. J., & Van Den Born, B.-J. H. (2018). Isolated systolic hypertension of the young and its association with central blood pressure in a large multi-ethnic population. The HELIUS study. European Journal of Preventive Cardiology, 25(13), 1351–1359. https://doi.org/10.1177/2047487318777430
6. Grebla, R. C., Rodriguez, C. J., Borrell, L. N., & Pickering, T. G. (2010). Prevalence and Determinants of Isolated Systolic Hypertension among Young Adults: The 1999 – 2004 U.S. National Health and Nutrition Examination Survey. Journal of Hypertension, 28(1), 15–23. https://doi.org/10.1097/HJH.0b013e328331b7ff
7. Liu, X., Rodriguez, C. J., & Wang, K. (2015). Prevalence and trends of isolated systolic hypertension among untreated adults in the United States. Journal of the American Society of Hypertension : JASH, 9(3), 197–205. https://doi.org/10.1016/j.jash.2015.01.002
8. Palatini, P., Rosei, E. A., Avolio, A., Bilo, G., Casiglia, E., Ghiadoni, L., Giannattasio, C., Grassi, G., Jelakovich, B., Julius, S., Mancia, G., McEniery, C. M., O’Rourke, M. F., Parati, G., Pauletto, P., Pucci, G., Saladini, F., Strazzullo, P., Tsioufis, K., … Zanchetti, A. (2018). Isolated systolic hypertension in the young: A position paper endorsed by the European Society of Hypertension. Journal of Hypertension, 36(6), 1222–1236. https://doi.org/10.1097/HJH.0000000000001726
9. Atasoy, S., Middeke, M., Johar, H., Peters, A., Heier, M., & Ladwig, K.-H. (2022). Cardiovascular mortality risk in young adults with isolated systolic hypertension: Findings from population-based MONICA/KORA cohort study. Journal of Human Hypertension, 36(12), 1059–1065. https://doi.org/10.1038/s41371-021-00619-z
10. Mahmud, A. (2003). Spurious systolic hypertension of youth: Fit young men with elastic arteries. American Journal of Hypertension, 16(3), 229–232. https://doi.org/10.1016/S0895-7061(02)03255-7
11. O’Rourke, M. F., Vlachopoulos, C., & Graham, R. M. (2000). Spurious systolic hypertension in youth. Vascular Medicine (London, England), 5(3), 141–145. https://doi.org/10.1177/1358836X0000500303
12. Janiec, S., Stępień, K., Skorek, P., Kołodziejski, M., Stępień, A., Olszanecka, A., & Czarnecka, D. (2017). Isolated systolic hypertension—Evaluation of the scale of the problem among medical students—Pilot study. Arterial Hypertension, 21(3), 132–139. https://doi.org/10.5603/AH.a2017.0018
13. Yano, Y., Stamler, J., Garside, D. B., Daviglus, M. L., Franklin, S. S., Carnethon, M. R., Liu, K., Greenland, P., & Lloyd-Jones, D. M. (2015). Isolated systolic hypertension in young and middle-aged adults and 31-year risk for cardiovascular mortality: The Chicago Heart Association Detection Project in Industry study. Journal of the American College of Cardiology, 65(4), 327–335. https://doi.org/10.1016/j.jacc.2014.10.060
14. Kulkarni, S., Faconti, L., Partridge, S., Delles, C., Glover, M., Lewis, P., Gray, A., Hodson, E., Macintyre, I., Maniero, C., McEniery, C. M., Sinha, M. D., Walsh, S. B., & Wilkinson, I. B. (2024). Investigation and management of young-onset hypertension: British and Irish hypertension society position statement. Journal of Human Hypertension, 38(7), 544–554. https://doi.org/10.1038/s41371-024-00922-5
15. O’Rourke, M. F., & Hashimoto, J. (2007). Mechanical Factors in Arterial Aging. JACC, 50(1), 1–13. https://doi.org/10.1016/j.jacc.2006.12.050
16. Hulsen, H. T., Nijdam, M.-E., Bos, W.-J., Uiterwaal, C. S., Oren, A., Grobbee, D. E., & Bots, M. (2006). Spurious systolic hypertension in young adults; prevalence of high brachial systolic blood pressure and low central pressure and its determinants. Journal of Hypertension, 24(6), 1027–1032. https://doi.org/10.1097/01.hjh.0000226191.36558.9c
17. McEniery, C. M., Franklin, S. S., Cockcroft, J. R., & Wilkinson, I. B. (2016). Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be Treated. Hypertension, 68(2), 269–275. https://doi.org/10.1161/HYPERTENSIONAHA.116.06547
18. McEniery, C. M., Yasmin, Wallace, S., Maki-Petaja, K., McDonnell, B., Sharman, J. E., Retallick, C., Franklin, S. S., Brown, M. J., Lloyd, R. C., Cockcroft, J. R., & Wilkinson, I. B. (2005). Increased Stroke Volume and Aortic Stiffness Contribute to Isolated Systolic Hypertension in Young Adults. Hypertension, 46(1), 221–226. https://doi.org/10.1161/01.HYP.0000165310.84801.e0
19. Saladini, F., Dorigatti, F., Santonastaso, M., Mos, L., Ragazzo, F., Bortolazzi, A., Mattarei, M., Garavelli, G., Mormino, P., Palatini, P., & HARVEST Study Group. (2009). Natural history of hypertension subtypes in young and middle-age adults. American Journal of Hypertension, 22(5), 531–537. https://doi.org/10.1038/ajh.2009.21
20. Kanegae, H., Oikawa, T., Okawara, Y., Hoshide, S., & Kario, K. (2017). Which blood pressure measurement, systolic or diastolic, better predicts future hypertension in normotensive young adults? The Journal of Clinical Hypertension, 19(6), 603–610. https://doi.org/10.1111/jch.13015
21. Saladini, F., Santonastaso, M., Mos, L., Benetti, E., Zanatta, N., Maraglino, G., & Palatini, P. (2011). Isolated systolic hypertension of young-to-middle-age individuals implies a relatively low risk of developing hypertension needing treatment when central blood pressure is low. Journal of Hypertension, 29(7), 1311–1319. https://doi.org/10.1097/HJH.0b013e3283481a32
22. Obrycki, Ł., Feber, J., Brzezińska, G., & Litwin, M. (2021). Evolution of isolated systolic hypertension with normal central blood pressure in adolescents—Prospective study. Pediatric Nephrology (Berlin, Germany), 36(2), 361–371. https://doi.org/10.1007/s00467-020-04731-z
23. Lee, H., Yano, Y., Cho, S. M. J., Park, J. H., Park, S., Lloyd-Jones, D. M., & Kim, H. C. (2020). Cardiovascular Risk of Isolated Systolic or Diastolic Hypertension in Young Adults. Circulation, 141(22), 1778–1786. https://doi.org/10.1161/CIRCULATIONAHA.119.044838
24. Bo, Y., Yu, T., Guo, C., Chang, L.-Y., Huang, J., Wong, M. C. S., Tam, T., & Lao, X. Q. (2023). Isolated systolic or diastolic hypertension and mortality risk in young adults using the 2017 American College of Cardiology/American Heart Association blood pressure guideline: A longitudinal cohort study. Journal of Hypertension, 41(2), 271–279. https://doi.org/10.1097/HJH.0000000000003325
25. Paffenbarger, R. S., & Wing, A. L. (1971). Chronic disease in former college students. XI. Early precursors of nonfatal stroke. American Journal of Epidemiology, 94(6), 524–530. https://doi.org/10.1093/oxfordjournals.aje.a121351
26. Ettehad, D., Emdin, C. A., Kiran, A., Anderson, S. G., Callender, T., Emberson, J., Chalmers, J., Rodgers, A., & Rahimi, K. (2016). Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis. Lancet (London, England), 387(10022), 957–967. https://doi.org/10.1016/S0140-6736(15)01225-8
27. Pourbaix, R. de, Stępnik, J., Maj-Gnat, K., Wołoszynek, E., & Kielar, M. (2021). The role of food and nutrition in the prevention and pathogenesis of hypertension. Journal of Education, Health and Sport, 9(3), 375–380.
28. Hamrahian, S. M., & Falkner, B. (2022). Approach to Hypertension in Adolescents and Young Adults. Current Cardiology Reports, 24(2), 131–140. https://doi.org/10.1007/s11886-021-01632-x
29. Prejbisz, A., Dobrowolski, P., Doroszko, A., Olszanecka, A., Tycińska, A., Tykarski, A., Adamczak, M., Begier-Krasińska, B., Chrostowska, M., Dzida, G., Filipiak, K. J., Gaciong, Z., Gąsecki, D., Gierlotka, M., Grabowski, M., Grodzicki, T., Jankowski, P., Kamiński, K., Kapłon-Cieślicka, A., … Wolf, J. (2024). Guidelines for the management of hypertension in Poland 2024—The position of the Polish Society of Hypertension/Polish Cardiac Society Experts. Arterial Hypertension, 28(0), 91–146. https://doi.org/10.5603/ah.103916
30. Scott, H., Barton, M. J., & Johnston, A. N. B. (2021). Isolated systolic hypertension in young males: A scoping review. Clinical Hypertension, 27, 12. https://doi.org/10.1186/s40885-021-00169-z
31. Overweight and obesity—BMI statistics. (n.d.). Retrieved 20 January 2026, from https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Overweight_and_obesity_-_BMI_statistics
32. Lurbe, E., & Redon, J. (2016). Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be Treated. Hypertension, 68(2), 276–280. https://doi.org/10.1161/HYPERTENSIONAHA.116.06548
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Copyright (c) 2026 Laura Janasik, Patrycja Kociucka, Krzysztof Sadowski, Julia Modelska, Anita Jeleń, Anna Podolska, Karolina Paluchowicz, Katarzyna Siwicka, Konrad Szewczyk
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