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Pulsatile blood pressure component as predictor of mortality in hypertension: a meta-analysis of clinical trial

Jerzy Gasowski1, Robert H Fagard, Jan A Staessen

  • 1Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.

Journal of Hypertension
|January 16, 2002
PubMed

Insights

Pulse pressure, not mean pressure, independently predicts mortality in hypertensive patients. Wider pulse pressure increases the risk of total and cardiovascular mortality, suggesting a need to consider both components of arterial pressure.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Epidemiology

Background:

  • Current hypertension guidelines focus solely on systolic and diastolic blood pressures.
  • Arterial pressure comprises pulsatile (pulse pressure) and steady (mean pressure) components.
  • The independent prognostic value of these components in hypertension is not fully elucidated.

Purpose of the Study:

  • To investigate the independent roles of pulse pressure and mean pressure as predictors of mortality.
  • To determine if pulse pressure or mean pressure is a stronger predictor of adverse outcomes in hypertensive patients.

Main Methods:

  • Meta-analysis of individual patient data from seven randomized clinical trials.
  • Inclusion of control groups from trials in patients with systolo-diastolic or isolated systolic hypertension.
  • Cox proportional hazard regression models used to calculate relative hazard rates for pulse pressure and mean pressure, adjusted for covariates.

Main Results:

  • A 10 mmHg increase in pulse pressure was independently associated with a 6% increase in total mortality risk (P=0.001).
  • Pulse pressure predicted cardiovascular mortality and fatal coronary events, but not fatal stroke due to insufficient sample size.
  • Mean pressure was not identified as an independent predictor of these mortality outcomes.

Conclusions:

  • Pulse pressure, rather than mean pressure, is significantly associated with an increased risk of fatal events in hypertensive patients.
  • These findings hold true across a broad spectrum of hypertensive individuals.
  • Age-specific interactions suggest differential prognostic importance of pulse and mean pressures for specific cardiovascular events.
Abstract

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