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Pulsatile versus steady component of blood pressure: a cross-sectional analysis and a prospective analysis on
Insights
The steady component of blood pressure strongly predicts cardiovascular death in both men and women. The pulsatile component may also be an independent risk factor in women over 55.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Epidemiology
Background:
- Traditional blood pressure assessment focuses on systolic and diastolic levels.
- Blood pressure comprises steady (mean arterial pressure) and pulsatile (pulse arterial pressure) components.
- Understanding the independent prognostic value of these components is crucial for cardiovascular risk stratification.
Purpose of the Study:
- To investigate the relationship between steady and pulsatile arterial pressure components and cardiovascular risk factors.
- To determine the prognostic significance of these components for cardiovascular mortality.
- To address the challenge of multicollinearity between steady and pulsatile pressure measures.
Main Methods:
- Utilized principal component analysis to derive independent steady and pulsatile component indices.
- Cross-sectional analysis examined associations with cardiovascular risk factors and left ventricular hypertrophy.
- Longitudinal survival analysis assessed cardiovascular mortality over a mean follow-up of 9.5 years in 18,336 men and 9,351 women aged 40-69.
Main Results:
- The steady component index showed stronger cross-sectional associations with risk factors than the pulsatile component index.
- Left ventricular hypertrophy was associated with the pulsatile component index in both sexes.
- The steady component index was a significant predictor of all-cause cardiovascular death in both sexes.
- In women, the pulsatile component index was linked to increased coronary artery disease mortality and decreased stroke mortality.
Conclusions:
- The steady component of blood pressure is a robust predictor of cardiovascular mortality in both men and women.
- The pulsatile component may represent an independent risk factor for cardiovascular death, particularly in women over 55 years.
- This study highlights the importance of considering both steady and pulsatile aspects of blood pressure for comprehensive cardiovascular risk assessment.
Abstract:
Studies on the prognostic significance of blood pressure on cardiovascular disease have essentially investigated the levels of diastolic or systolic blood pressure. However, blood pressure may also be divided into two other components: steady (mean arterial pressure) and pulsatile (pulse arterial pressure). The relations of these two components with cardiovascular risk factors and cardiovascular mortality were investigated in 18,336 men and 9,351 women aged 40-69 years, who were followed up for a mean period of 9.5 years. However, the interpretation of the relations is complicated by the strong correlation existing between these two components. A principal component analysis was performed to obtain two independent parameters: a steady and a pulsatile component index, strongly correlated with mean and pulse arterial pressure, respectively. In the cross-sectional analysis, relations were stronger with the steady component index than with the pulsatile component index; an association was found between left ventricular hypertrophy and the pulsatile component index in both sexes. The survival analysis was not performed in women under 55 as only 11 cardiovascular deaths occurred in this group. The steady component index was a strong prognostic factor of all types of cardiovascular death in both sexes. In women, the pulsatile component index was positively correlated to death from coronary artery disease and inversely correlated to stroke. In conclusion, the steady component of blood pressure is a strong risk factor for cardiovascular death in both sexes; the pulsatile component could be a risk factor independent of the steady component in women older than 55 years.