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Predictive power of 24-h ambulatory pulse pressure and its components for mortality and cardiovascular outcomes in 11 848 participants recruited from 13 populations
B. Gavish, M. Bursztyn, L. Thijs, DM. Wei, JD. Melgarejo, ZY. Zhang, J. Boggia, TW. Hansen, K. Asayama, T. Ohkubo, M. Kikuya, WY. Yang, K. Stolarz-Skrzypek, S. Malyutina, E. Casiglia, L. Lind, Y. Li, K. Kawecka-Jaszcz, J. Filipovský, V....
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu časopisecké články, práce podpořená grantem, Research Support, N.I.H., Extramural
Grantová podpora
R03 AG054186
NIA NIH HHS - United States
R13 AG066391
NIA NIH HHS - United States
- MeSH
- ambulantní monitorování krevního tlaku MeSH
- dospělí MeSH
- hypertenze * MeSH
- kardiovaskulární nemoci * diagnóza MeSH
- kohortové studie MeSH
- krevní tlak fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- systola fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
BACKGROUND: The role of pulse pressure (PP) 'widening' at older and younger age as a cardiovascular risk factor is still controversial. Mean PP, as determined from repeated blood pressure (BP) readings, can be expressed as a sum of two components: 'elastic PP' (elPP) and 'stiffening PP' (stPP) associated, respectively, with stiffness at the diastole and its relative change during the systole. We investigated the association of 24-h ambulatory PP, elPP, and stPP ('PP variables') with mortality and composite cardiovascular events in different age classes. METHOD: Longitudinal population-based cohort study of adults with baseline observations that included 24-h ambulatory BP. Age classes were age 40 or less, 40-50, 50-60, 60-70, and over 70 years. Co-primary endpoints were total mortality and composite cardiovascular events. The relative risk expressed by hazard ratio per 1SD increase for each of the PP variables was calculated from multivariable-adjusted Cox regression models. RESULTS: The 11 848 participants from 13 cohorts (age 53 ± 16 years, 50% men) were followed for up for 13.7 ± 6.7 years. A total of 2946 participants died (18.1 per 1000 person-years) and 2093 experienced a fatal or nonfatal cardiovascular event (12.9 per 1000 person-years). Mean PP, elPP, and stPP were, respectively, 49.7, 43.5, and 6.2 mmHg, and elPP and stPP were uncorrelated ( r = -0.07). At age 50-60 years, all PP variables displayed association with risk for almost all outcomes. From age over 60 years to age over 70 years, hazard ratios of of PP and elPP were similar and decreased gradually but differently for pulse rate lower than or higher than 70 bpm, whereas stPP lacked predictive power in most cases. For age 40 years or less, elPP showed protective power for coronary events, whereas stPP and PP predicted stroke events. Adjusted and unadjusted hazard ratio variations were similar over the entire age range. CONCLUSION: This study provides a new basis for associating PP components with outcome and arterial properties in different age groups and at different pulse rates for both old and young age. The similarity between adjusted and unadjusted hazard ratios supports the clinical usefulness of PP components but further studies are needed to assess the prognostic significance of the PP components, especially at the young age.
Asociación Española Primera de Socorros Mutuos Montevideo Uruguay
Biomedical Science Group University of Leuven Leuven Belgium
Conway Institute University College Dublin Dublin Ireland
Department of Hygiene and Public Health Teikyo University School of Medicine Tokyo
Department of Hypertension Medical University of Gdañsk Gdañsk Poland
Department of Medicine University of Padova Padova Italy
Faculty of Medicine Charles University Pilsen Czech Republic
Laboratory of Neurosciences Faculty of Medicine University of Zulia Maracaibo Zulia Venezuela
Research Institute Alliance for the Promotion of Preventive Medicine Mechelen
Stroke and Hypertension Unit Blanchardstown Dublin Ireland
Tohoku Institute for Management of Blood Pressure Sendai Japan
Citace poskytuje Crossref.org
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- $a Predictive power of 24-h ambulatory pulse pressure and its components for mortality and cardiovascular outcomes in 11 848 participants recruited from 13 populations / $c B. Gavish, M. Bursztyn, L. Thijs, DM. Wei, JD. Melgarejo, ZY. Zhang, J. Boggia, TW. Hansen, K. Asayama, T. Ohkubo, M. Kikuya, WY. Yang, K. Stolarz-Skrzypek, S. Malyutina, E. Casiglia, L. Lind, Y. Li, K. Kawecka-Jaszcz, J. Filipovský, V. Tikhonoff, N. Gilis-Malinowska, E. Dolan, E. Sandoya, K. Narkiewicz, JG. Wang, Y. Imai, GE. Maestre, E. O'Brien, JA. Staessen, International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome Investigators
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- $a BACKGROUND: The role of pulse pressure (PP) 'widening' at older and younger age as a cardiovascular risk factor is still controversial. Mean PP, as determined from repeated blood pressure (BP) readings, can be expressed as a sum of two components: 'elastic PP' (elPP) and 'stiffening PP' (stPP) associated, respectively, with stiffness at the diastole and its relative change during the systole. We investigated the association of 24-h ambulatory PP, elPP, and stPP ('PP variables') with mortality and composite cardiovascular events in different age classes. METHOD: Longitudinal population-based cohort study of adults with baseline observations that included 24-h ambulatory BP. Age classes were age 40 or less, 40-50, 50-60, 60-70, and over 70 years. Co-primary endpoints were total mortality and composite cardiovascular events. The relative risk expressed by hazard ratio per 1SD increase for each of the PP variables was calculated from multivariable-adjusted Cox regression models. RESULTS: The 11 848 participants from 13 cohorts (age 53 ± 16 years, 50% men) were followed for up for 13.7 ± 6.7 years. A total of 2946 participants died (18.1 per 1000 person-years) and 2093 experienced a fatal or nonfatal cardiovascular event (12.9 per 1000 person-years). Mean PP, elPP, and stPP were, respectively, 49.7, 43.5, and 6.2 mmHg, and elPP and stPP were uncorrelated ( r = -0.07). At age 50-60 years, all PP variables displayed association with risk for almost all outcomes. From age over 60 years to age over 70 years, hazard ratios of of PP and elPP were similar and decreased gradually but differently for pulse rate lower than or higher than 70 bpm, whereas stPP lacked predictive power in most cases. For age 40 years or less, elPP showed protective power for coronary events, whereas stPP and PP predicted stroke events. Adjusted and unadjusted hazard ratio variations were similar over the entire age range. CONCLUSION: This study provides a new basis for associating PP components with outcome and arterial properties in different age groups and at different pulse rates for both old and young age. The similarity between adjusted and unadjusted hazard ratios supports the clinical usefulness of PP components but further studies are needed to assess the prognostic significance of the PP components, especially at the young age.
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