Do estimated 24-h pulse pressure components affect outcome? The Ohasama study

Area of Science:

• Cardiovascular Medicine
• Hypertension Research
• Epidemiology

Background:

• Twenty-four-hour ambulatory pulse pressure (PP) is a recognized predictor of patient outcomes.
• Recently identified components of PP include elastic (elPP) and systolic stiffening (stPP) properties.
• The prognostic value of these PP components requires further investigation in diverse populations.

Purpose of the Study:

• To evaluate the influence of elastic (elPP) and systolic stiffening (stPP) components of 24-hour ambulatory pulse pressure on cardiovascular outcomes.
• To assess the predictive power of elPP and stPP for total mortality, cardiovascular disease (CVD) mortality, and stroke morbidity in the Ohasama study population.

Main Methods:

• Utilized data from the Ohasama study, including participants without a history of cardiovascular disease (CVD).
• Derived elPP and stPP from 24-hour ambulatory blood pressure monitoring (AMBP) using a nonlinear pressure-volume relationship model.
• Employed Cox regression models to estimate outcome predictive power, adjusting for various demographic, clinical, and treatment-related factors.

Main Results:

• Overall, PP, elPP, and stPP showed nonsignificant associations with total mortality, CVD mortality, and stroke morbidity after multivariable adjustment.
• However, in participants with a pulse rate at or below the median (≤68.5 bpm), elPP significantly predicted both total and CVD mortality.
• This predictive association of elPP was particularly pronounced in the subgroup of treated hypertensive patients with slower pulse rates.

Conclusions:

• Elastic pulse pressure (elPP), but not systolic stiffening pressure (stPP), emerged as a significant predictor of total and CVD mortality in a Japanese population with slower pulse rates.
• These findings were observed even after adjusting for mean arterial pressure and conventional risk factors, especially within the subgroup of treated hypertensive individuals.
• The study suggests that elPP may offer valuable prognostic information for cardiovascular outcomes in specific patient subpopulations.