Unusual hypertensive phenotypes: what is their significance?

According to Webster,1 the terms “spurious,” “artifactual,” or “pseudo” denote false or deceptive resemblance. These terms when used specifically to hypertension refer to something that does not correspond with reality—a false perception; implicit in this definition is normalcy or a benign prognosis. Before discussion of the pros and cons of spurious, artifactual, or pseudohypertension, one should dispose of faulty technique (systematic error, terminal digit preference, or observer bias) in measuring blood pressure (BP), including cuff-inflation hypertension and failure to use the proper size cuff in obese arms as causes of erroneously high BP values. In this review, we limit our focus to the use of the terms “spurious,” “artifactual,” or “pseudohypertension” in relation to 3 unusual hypertensive phenotypes: (1) spurious isolated systolic hypertension (ISH) in late teenagers to young adults, defined as systolic BP (SBP) ≥140 mm Hg and diastolic BP (DBP) <90 mm Hg; (2) artifactual or benign isolated diastolic hypertension (IDH) in young to early middle-aged adults defined as a SBP <140 mm Hg and DBP ≥90 mm Hg; and (3) pseudohypertension in the elderly, presenting rarely with noncompressible artery syndrome and, more commonly, an elevated diastolic brachial artery pressure assessed indirectly with a cuff and sphygmomanometer, in the context of a “normal” intra-arterial pressure assessed invasively. The purpose of this review is to present evidence for and against with regard to the validity of these 3 forms of unusual hypertensive phenotypes. ### ISH in Late Teenagers to Young Adults Although ISH is usually associated with the elderly, ISH is also the majority hypertensive subtype in adolescents2 and young adults.3 The phenomenon of spurious systolic hypertension in young individuals was first described by O'Rourke et al4 in 6 young males, aged 14 to 23 years. The investigators noted elevated brachial SBP (150–176 mm Hg) but normal brachial DBP (55–85 mm Hg), and …