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Pulse pressure and adverse outcomes in women: a report from the Women's Ischemia Syndrome Evaluation (WISE)

R David Anderson1, B Clay Sizemore, Genevieve M Barrow

  • 1Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.

American Journal of Hypertension
|September 20, 2008
PubMed

Insights

Brachial pulse pressure (PP) is a stronger predictor of cardiovascular mortality and adverse outcomes in women with suspected coronary artery disease (CAD) than other blood pressure measures. Higher PP indicates increased risk.

Area of Science:

  • Cardiovascular Medicine
  • Hypertension Research
  • Clinical Cardiology

Background:

  • Emerging data suggest brachial pulse pressure (PP) may surpass systolic (SBP) and diastolic blood pressure (DBP) in predicting patient outcomes.
  • Investigating the comparative predictive value of PP versus SBP/DBP is crucial for risk stratification in women with suspected coronary artery disease (CAD).

Purpose of the Study:

  • To determine the relative contributions of PP, SBP, DBP, and mean arterial pressure (MAP) to adverse cardiovascular outcomes in women with suspected myocardial ischemia.
  • To identify which blood pressure component is the most significant independent predictor of mortality and adverse events.

Main Methods:

  • Prospective cohort study of 857 women undergoing angiography for suspected myocardial ischemia.
  • Baseline blood pressure components (PP, SBP, DBP, MAP) and clinical characteristics were recorded.
  • Multivariate Cox regression models were used to assess the association between blood pressure indices and clinical outcomes over a mean follow-up of 5.2 years.

Main Results:

  • Univariate analysis revealed higher PP was significantly associated with increased risk of cardiovascular (CV) mortality and adverse CV outcomes compared to SBP, DBP, or MAP.
  • Multivariate analysis indicated both PP and SBP predicted adverse CV outcomes, but only PP independently predicted higher CV mortality.
  • When PP and SBP were analyzed together, PP remained the sole independent predictor of adverse CV events.

Conclusions:

  • Brachial pulse pressure (PP) is a more potent predictor of adverse outcomes in women with suspected CAD and myocardial ischemia than SBP, DBP, or MAP.
  • An 18% excess mortality risk was observed for every 10 mm Hg increase in PP.
  • Further research into the pathophysiologic mechanisms and therapeutic strategies targeting PP is warranted.
Abstract

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