Clinic and ambulatory pulse pressure segregate a cluster of cardiovascular risk factors

Office pulse pressure (PP) has been found to be independently associated with cardiovascular morbidity and mortality. While there is evidence that 24 h blood pressure (BP) is a better marker of the cardiovascular complications of hypertension than office BP, this information is still lacking in regard to PP. The aim of the present study was, therefore, to evaluate possible differences between office and 24 h PP in their relationship with cardiovascular risk profile. This cross-sectional study was performed in a group of 175 (104 M, 71 F) hypertensives (43 never treated before the study) free of clinical evidence of target organ disease. BP was measured at rest and during 24 h monitoring; cardiac structure and function was studied by ultrasounds; biochemical analyses were performed to evaluate some parameters of lipid and carbohydrate metabolism. Patients were divided into tertiles of office PP and of 24 h PP. Those in the highest tertile of PP had a significantly higher office and 24 h systolic BP along with a reduction in peripheral insulin sensitivity. Regarding cardiac structure and function, a significantly higher prevalence of concentric left ventricular hypertrophy (23 vs 55%; P=0.05) and an initial impairment of diastolic function with increase of the A wave was detected in hypertensives with higher PP. No difference between office and 24 h PP in detecting patients at higher cardiovascular risk was observed. In conclusion, office and 24 h pulse pressures were both able to segregate patients with a cluster of cardiovascular risk factors.