Related Experiment Videos
Pulse pressure and subclinical cardiovascular damage in primary hypertension
Francesca Viazzi1, Giovanna Leoncini, Denise Parodi
1Department of Internal Medicine, University of Genoa, Genoa, Italy.
Insights
High pulse pressure (PP) is linked to preclinical cardiovascular damage in hypertensive patients. This finding helps identify individuals at increased risk for cardiovascular events.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Background:
- High pulse pressure (PP) is increasingly associated with atherosclerosis and cardiovascular events.
- Untreated primary hypertension in middle-aged individuals presents a critical population for studying cardiovascular damage.
- Investigating the link between PP and subclinical damage is crucial for early risk stratification.
Purpose of the Study:
- To examine the relationship between pulse pressure and subclinical cardiovascular damage.
- To assess target organ damage indicators in relation to pulse pressure in hypertensive patients.
- To determine if PP is an independent predictor of cardiovascular damage.
Main Methods:
- Pulse pressure (PP) calculated from systolic (SBP) and diastolic (DBP) blood pressure.
- Left ventricular mass index (LVMI) assessed via echocardiography for left ventricular hypertrophy (LVH).
- Carotid intima-media thickness (IMT) measured by ultrasound; albuminuria assessed via albumin to creatinine ratio (ACR).
Main Results:
- PP positively correlated with age, disease duration, LDL cholesterol, LVMI, IMT, and ACR.
- Higher PP quartiles associated with increased LVMI, IMT, and ACR.
- PP and ACR independently predicted LVMI and IMT; higher PP linked to greater target organ damage.
Conclusions:
- Pulse pressure is an independent marker of preclinical cardiovascular damage in hypertensive patients.
- PP can identify younger hypertensive individuals at higher risk of cardiovascular events.
- Measuring PP aids in risk stratification for cardiovascular disease progression.
Background:
High pulse pressure (PP) values have recently been implicated in the development and progression of large vessel atherosclerosis, small vessel disease, and in the occurrence of cardiovascular events. The aim of the present study is to investigate the relationship between PP and subclinical cardiovascular damage in a cohort of unselected middle-aged patients (204 male, 129 female) with untreated primary hypertension.
Methods:
PP was calculated as the difference between systolic (SBP) and diastolic blood pressure (DBP). Left ventricular mass index (LVMI) was assessed by M-B mode echocardiography (LVH=LVMI>51 g/m(2.7)), and carotid intima-media thickness (IMT) by high-resolution US scan. Albuminuria was measured as the albumin to creatinine ratio (ACR) in three non-consecutive first morning urine samples.
Results:
PP was positively correlated to gender (P<0.05), duration of disease (P<0.001), age (P<0.0001), LDL cholesterol (P=0.007), and to early signs of target organ damage (TOD), namely LVMI (P<0.0001), IMT (P<0.0001), and ACR (P=0.036). Patients in the upper quartile of PP showed higher LVMI (P<0.001), thicker carotid walls (P<0.001), as well as higher ACR (P<0.04). Multiple linear regression analysis showed that PP and ACR independently influence LVMI (F=26.476, r(2)=0.29, P<0.0001) and IMT (F=17.813, r(2)=0.26, P<0.0001). Patients with LVH, increased carotid IMT and microalbuminuria showed higher PP values as compared with those with lesser degrees of target organ involvement (F=4.97, P<0.003 inter-group comparison). Moreover, the risk of having the simultaneous occurrence of various signs of TOD increases significantly with each SD increase in PP or SBP, but is not influenced by DBP.
Conclusions:
PP is an independent marker of preclinical cardiovascular damage in relatively young patients with primary hypertension and, therefore, can be useful for identifying those at higher risk of cardiovascular events.