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[Pulse pressure and coronary disease]
1Service de cardiologie, hôpital européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris. Nicolas.danchin@egp.ap-hop-paris.fr
Insights
Pulse pressure, the difference between systolic and diastolic blood pressure, is increasingly recognized as a significant predictor of cardiovascular events. Elevated pulse pressure is linked to coronary artery disease, myocardial infarction, and restenosis after procedures.
Area of Science:
- Cardiology
- Vascular Physiology
Context:
- Pulse pressure (PP) has emerged as a critical clinical parameter over the last decade.
- Observational studies link elevated PP to increased risk of coronary events, particularly in the elderly.
- High PP correlates with angiographically confirmed coronary artery disease and elevated C-reactive protein levels.
Purpose:
- To synthesize the growing evidence on the prognostic value of pulse pressure in cardiovascular disease.
- To highlight the association between pulse pressure and various adverse cardiovascular outcomes.
Summary:
- Pulse pressure is a significant predictor of late coronary events in the general population.
- In patients with established coronary artery disease, PP is a prognostic factor post-myocardial infarction and revascularization.
- Studies indicate a correlation between high PP and restenosis after percutaneous transluminal coronary angioplasty.
Impact:
- Pulse pressure measurement offers a valuable, non-invasive tool for risk stratification in cardiovascular patients.
- Understanding the role of PP can refine clinical management strategies for coronary artery disease.
- Further research into the mechanisms linking PP to cardiovascular events is warranted.
Abstract:
The concept of pulse pressure has been developed over the past 10 years. Large observational studies in the general population have shown a link between pulse pressure and risk of late coronary events. The correlation between pulse pressure and coronary events appears particularly strong in the elderly. More limited data have shown that a high level of pulse pressure was related to angiographically documented coronary artery disease; recently, a correlation between pulse pressure and a high level of C reactive protein has been evidenced in the NHANES cohort. In patients with known coronary artery disease, pulse pressure is a prognostic factor, both after myocardial infarction with left ventricular dysfunction (SAVE trial) and after myocardial revascularization by coronary surgery or angioplasty (BARI randomised trial and registry). In addition, two small-sized studies have shown a strong correlation between pulse pressure and restenosis after conventional percutaneous transluminal coronary angioplasty.