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J Am Coll Cardiol. 2009 Oct 27;54(18):1730-4. doi: 10.1016/j.jacc.2009.05.070.

High central pulse pressure is independently associated with adverse cardiovascular outcome the strong heart study.

Author information

1
Weill Cornell Medical College, New York, New York 10021, USA. mroman@med.cornell.edu

Abstract

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 (> or =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 > or =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 > or =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.

PMID:
19850215
PMCID:
PMC3164777
DOI:
10.1016/j.jacc.2009.05.070
[Indexed for MEDLINE]
Free PMC Article
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