Hypothesis: it is time to reconsider phenotypes in hypertension

Abstract

The study of genes and mechanisms associated with hypertension is hampered by the heterogeneity of hypertensive patients. Refining the definition of hypertension is a potential means of improving the clarity of mechanistic studies, but the lack of intermediate phenotypes hinders the assessment of causal relationships. Looking at younger individuals and hemodynamic subsets of hypertension is one such refinement. The authors argue that the separate analysis of patients with isolated diastolic hypertension, predominantly diastolic hypertension, and isolated systolic hypertension in the young in combination with common biomarkers may be an initial step to decrease heterogeneity within patient subsets, thus providing new avenues for genetic and pathophysiological studies.

Figure

Predominantly diastolic hypertension (PDH) encompasses isolated diastolic hypertension (IDH) and systo‐diastolic hypertension (SDH) with a narrow pulse pressure. Arrows on the bottom demonstrate how progression of disease can occur (from IDH to SDH and then isolated systolic hypertension [ISH]), but patients may become hypertensive at any stage and also skip or reverse categories.