Pulse Pressure Associated with Multiple Adverse Cardiovascular Outcomes

Pulse pressure (PP) was associated with multiple adverse cardiovascular outcomes and had prognostic utility beyond mean arterial pressure, according to data recently published in the Journal of the American College of Cardiology.

Because PP is a known risk factor of cardiovascular disease (CVD) and has provided valuable prognostic information for specific populations, researchers sought to determine whether PP is associated with major adverse cardiovascular outcomes independently of mean arterial pressure.

The analysis included 45 087 participants from the REACH (Reduction of Atherothrombosis for Continued Health) registry. The registry evaluated patients with clinical atherothrombotic disease and risk factors for its development.

Researchers conducted univariate and multivariate regression analyses to determine the association between PP and cardiovascular outcomes including cardiovascular death, myocardial infarction, stroke, cardiovascular hospitalization, and combined outcomes.

The mean age of the cohort was 68 ± 10 years and 35% were women. Comorbidities included hypertension (81%), hypercholesterolemia (70%), coronary artery disease (58%),  diabetes (44%), and atherothrombotic disease (82%). The mean blood pressure was 138 ± 19/79 ± 11 mm Hg, with a mean PP of 49 ± 16 mm Hg.

“Strong relationships were observed in participants without established atherothrombotic disease, suggesting that despite being lower risk, PP still had prognostic value,” the authors wrote. “In participants older than 60 years of age, PP was associated with nonfatal MI and cardiovascular hospitalization…Therefore, the resultant PP widening becomes a more accurate assessment of vascular bed compliance and cardiovascular risk.”

The univariate analysis showed that increasing PP quartile was associated with worse outcomes among all adverse events (P<.05).

When researchers adjusted for sex, age, smoking status, hypercholesterolemia history, diabetes history, aspirin use, blood pressure medication use, and mean arterial pressure, the PP quartile was still associated with all outcomes except stroke and cardiovascular death (P<.05).

“These results are particularly relevant because the population reflects many modern clinical practices, given the large burden of atherothrombotic disease studied here. PP, which is readily available in the office setting, can help risk stratify high-risk patients,” the authors concluded.

Reference

Selvaraj S, Steg G, Elbez Y, et al. Pulse pressure and risk for cardiovascular events in patient with atherothrombosis: from the REACH registry. J Am Coll Cardiol. 2016;67(4):392-403. doi: 10.1016/j.jacc.2015.10.084.