TY - JOUR
T1 - High Central Pulse Pressure Is Independently Associated With Adverse Cardiovascular Outcome. The Strong Heart Study
AU - Roman, Mary J.
AU - Devereux, Richard B.
AU - Kizer, Jorge R.
AU - Okin, Peter M.
AU - Lee, Elisa T.
AU - Wang, Wenyu
AU - Umans, Jason G.
AU - Calhoun, Darren
AU - Howard, Barbara V.
PY - 2009/10/27
Y1 - 2009/10/27
N2 - Objectives: This study was designed to facilitate clinical use of central pulse pressure (PP). We sought to determine a value that might predict adverse outcome and thereby provide a target for assessment of intervention strategies. Background: We previously documented that central PP more strongly relates to carotid hypertrophy and extent of atherosclerosis and, more importantly, better predicts incident cardiovascular disease (CVD) than brachial PP. Methods: Radial applanation tonometry was performed in the third Strong Heart Study examination to determine central blood pressure. Cox regression analyses were performed using pre-specified covariates and quartiles of central and brachial PP. Results: Among 2,405 participants without prevalent CVD, 344 suffered CVD events during 5.6 ± 1.7 years. Quartiles of central PP (p < 0.001) predicted outcome more strongly than quartiles of brachial PP (p = 0.052). With adjustment for covariates, only the event rate in the fourth quartile of central PP (≥50 mm Hg) was significantly higher than that in the first quartile (hazard ratio [HR]: 1.69, 95% confidence interval [CI]: 1.20 to 2.39, p = 0.003). Central PP ≥50 mm Hg was related to outcome in both men (HR: 2.06, 95% CI: 1.39 to 3.04, p < 0.001) and women (HR: 2.03, 95% CI: 1.55 to 2.65, p < 0.001); in participants with (HR: 1.84, 95% CI: 1.41 to 2.39, p < 0.001) and without diabetes (HR: 1.91, 95% CI: 1.29 to 2.83, p = 0.001); and in individuals younger (HR: 2.51, 95% CI: 1.59 to 3.95, p < 0.001) and older (HR: 1.53, 95% CI: 1.19 to 1.97, p = 0.001) than the age of 60 years. Conclusions: Central PP ≥50 mm Hg predicts adverse CVD outcome and may serve as a target in intervention strategies if confirmed in other populations and in prospective studies.
AB - Objectives: This study was designed to facilitate clinical use of central pulse pressure (PP). We sought to determine a value that might predict adverse outcome and thereby provide a target for assessment of intervention strategies. Background: We previously documented that central PP more strongly relates to carotid hypertrophy and extent of atherosclerosis and, more importantly, better predicts incident cardiovascular disease (CVD) than brachial PP. Methods: Radial applanation tonometry was performed in the third Strong Heart Study examination to determine central blood pressure. Cox regression analyses were performed using pre-specified covariates and quartiles of central and brachial PP. Results: Among 2,405 participants without prevalent CVD, 344 suffered CVD events during 5.6 ± 1.7 years. Quartiles of central PP (p < 0.001) predicted outcome more strongly than quartiles of brachial PP (p = 0.052). With adjustment for covariates, only the event rate in the fourth quartile of central PP (≥50 mm Hg) was significantly higher than that in the first quartile (hazard ratio [HR]: 1.69, 95% confidence interval [CI]: 1.20 to 2.39, p = 0.003). Central PP ≥50 mm Hg was related to outcome in both men (HR: 2.06, 95% CI: 1.39 to 3.04, p < 0.001) and women (HR: 2.03, 95% CI: 1.55 to 2.65, p < 0.001); in participants with (HR: 1.84, 95% CI: 1.41 to 2.39, p < 0.001) and without diabetes (HR: 1.91, 95% CI: 1.29 to 2.83, p = 0.001); and in individuals younger (HR: 2.51, 95% CI: 1.59 to 3.95, p < 0.001) and older (HR: 1.53, 95% CI: 1.19 to 1.97, p = 0.001) than the age of 60 years. Conclusions: Central PP ≥50 mm Hg predicts adverse CVD outcome and may serve as a target in intervention strategies if confirmed in other populations and in prospective studies.
KW - blood pressure determination
KW - detection and control
KW - elasticity
KW - hypertension
KW - vasculature
UR - http://www.scopus.com/inward/record.url?scp=70349990210&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70349990210&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2009.05.070
DO - 10.1016/j.jacc.2009.05.070
M3 - Article
C2 - 19850215
AN - SCOPUS:70349990210
SN - 0735-1097
VL - 54
SP - 1730
EP - 1734
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 18
ER -