Related Experiment Videos
Ambulatory pulse pressure: a potent predictor of total cardiovascular risk in hypertension
P Verdecchia1, G Schillaci, C Borgioni
1Unità Operativa di Malattie Cardiovascolari, Ospedale Regionale Raffaello Silvestrini, Perugia, Italy. verdec@tin.it
Insights
Ambulatory pulse pressure (PP) is a strong predictor of cardiovascular risk in hypertension. This study shows ambulatory PP is a more potent marker for cardiovascular morbidity than office PP.
Area of Science:
- Cardiology
- Hypertension Research
- Preventive Medicine
Background:
- Wide pulse pressure (PP) indicates increased artery stiffness and elevated cardiovascular (CV) risk.
- The prognostic value of ambulatory PP in essential hypertension is not well-established.
- Essential hypertension affects a significant portion of the adult population, necessitating accurate risk assessment.
Purpose of the Study:
- To investigate the prognostic value of ambulatory pulse pressure (PP) in predicting cardiovascular (CV) morbidity and mortality.
- To compare the predictive power of ambulatory PP with office PP and other CV risk factors.
- To determine if ambulatory PP offers superior risk stratification in patients with uncomplicated essential hypertension.
Main Methods:
- A cohort of 2010 untreated essential hypertension patients underwent baseline 24-hour ambulatory blood pressure (BP) monitoring.
- Follow-up averaged 3.8 years, with major CV events and mortality as outcome measures.
- Statistical analyses, including log-rank tests and Cox proportional hazards models, were used to assess risk prediction.
Main Results:
- Both office and ambulatory PP tertiles showed a significant association with increased rates of total and fatal CV events (P<0.01).
- Ambulatory PP demonstrated a greater reduction in CV morbidity prediction compared to office PP after controlling for risk factors (P<0.05).
- In all office PP tertiles, higher ambulatory PP levels correlated with increased CV morbidity and mortality (P<0.01).
Conclusions:
- Ambulatory pulse pressure is a potent and independent risk marker in essential hypertension.
- Ambulatory PP provides more accurate prediction of cardiovascular morbidity than office PP, even after adjusting for multiple risk factors.
- Routine use of ambulatory BP monitoring, including PP assessment, may enhance cardiovascular risk stratification in hypertensive patients.
Abstract:
A wide pulse pressure (PP) is a marker of increased artery stiffness and high cardiovascular (CV) risk. To investigate the prognostic value of ambulatory PP, which is currently unknown, we studied 2010 initially untreated subjects with uncomplicated essential hypertension (mean age, 51.7 years; 52% men). All subjects underwent baseline procedures including 24-hour noninvasive ambulatory blood pressure (BP) monitoring. The mean duration of follow-up was 3.8 years (range, 0 to 11 years), and CV morbidity and mortality were the outcome measures. There were 200 major CV events (2.61 per 100 person-years), 36 of which were fatal (0.47 per 100 person-years). In the 3 tertiles of the distribution of office PP, the rate of total CV events (per 100 persons per year) was 1.38, 2. 12, and 4.34, respectively, and that of fatal events was 0.12, 0.30, and 1.07 (log-rank test, both P<0.01). In the 3 tertiles of the distribution of average 24-hour PP, the rate of total CV events was 1.19, 1.81, and 4.92, and that of fatal events was 0.11, 0.17, and 1. 23 (log-rank test, both P<0.01). After controlling for several independent risk markers including white coat hypertension and nondipper status, we found that ambulatory PP was associated with the biggest reduction in the -2 log likelihood statistics for CV morbidity (P<0.05 versus office PP). In each of the 3 tertiles of office PP, CV morbidity and mortality increased from the first to the third tertile of average 24-hour ambulatory PP (log-rank test, all P<0.01). Age, left ventricular hypertrophy, and nondipper status were independent predictors of CV mortality, and the further predictive effect of ambulatory PP (P<0.001) was marginally but not significantly superior to that of office PP and average 24-hour systolic BP. We conclude that ambulatory PP is a potent risk marker in essential hypertension. CV morbidity is more closely predicted by ambulatory than by office PP even after control for multiple risk factors.