Different prognostic impact of 24-hour mean blood pressure and pulse pressure on stroke and coronary artery disease...

Area of Science:

• Cardiology
• Neurology
• Hypertension Research

Background:

• Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases.
• The distinct roles of steady (mean) and pulsatile blood pressure (BP) components in predicting these outcomes require further investigation.

Purpose of the Study:

• To test the hypothesis that steady and pulsatile blood pressure components have different influences on coronary artery disease and stroke in hypertensive subjects.
• To differentiate the predictive power of mean blood pressure and pulse pressure for cardiac versus cerebrovascular events.

Main Methods:

• Analysis of 24-hour ambulatory blood pressure monitoring data from 2311 essential hypertension patients.
• Long-term follow-up (mean 4.7 years) to record major cardiac and cerebrovascular events.
• Statistical adjustment for age, sex, diabetes, cholesterol, and smoking status.

Main Results:

• A 10 mm Hg increase in 24-hour pulse pressure (PP) independently raised cardiac event risk by 35% (95% CI 17% to 55%).
• Twenty-four-hour mean blood pressure (BP) was not a significant predictor of cardiac events after controlling for PP.
• A 10 mm Hg increase in 24-hour mean BP independently raised cerebrovascular event risk by 42% (95% CI 19% to 69%), with PP not reaching significance after controlling for mean BP.
• PP predicted fatal cardiac events; mean BP predicted fatal cerebrovascular events.

Conclusions:

• Ambulatory mean BP and PP have differential predictive effects on cardiac and cerebrovascular complications in hypertensive individuals.
• Pulse pressure is the dominant predictor of cardiac events.
• Mean blood pressure is the major independent predictor of cerebrovascular events.