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January 2, 2013

Aortic Stiffness and Incident Hypertension

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Department of Internal Medicine, University Hospital Maastricht, Maastricht, the Netherlands (a.protogerou@maastrichtuniversity.nl).

JAMA. 2013;309(1):29-30. doi:10.1001/jama.2012.68796

To the Editor: Dr Kaess and colleagues1 provided evidence from a longitudinal cohort study that arterial stiffening was associated with incident hypertension. The data should be evaluated within the context of the limitations acknowledged by the authors, as well as the lack of out-of-office blood pressure data.

On the basis of arterial mechanics, hypertension phenotypes are classified as isolated systolic hypertension, isolated diastolic hypertension, and combined systolic and diastolic hypertension. In isolated systolic hypertension, increased pulsatility is due to high arterial stiffness, whereas the 2 other types are mainly attributed to increased total peripheral resistance.2 At the age of 60 years (the mean age of the studied population), about 80% of the hypertensive population would be expected to present with isolated systolic hypertension and 20% with combined systolic and diastolic hypertension.3 It is therefore important to evaluate the data further on the basis of these phenotypes to better delineate the effect of arterial stiffness on the development of hypertension.