PREDICTIVE POWER OF 24-HOUR AMBULATORY PULSE PRESSURE AND ITS COMPONENTS FOR MORTALITY AND CARDIOVASCULAR OUTCOMES IN 11, 848 PARTICIPANTS RECRUITED FROM 13 POPULATIONS. (April 2021)

• Record Type: Journal Article
• Authors: Gavish, Benjamin; Bursztyn, Michael; Yang, Wen Yi; Thijs, Lutgrade; Zhang, Zhen-Yu; Boggia, José; Hansen, Tine W.; Asayama, Kei; Ohkubo, Takayoshi; Kikuya, Masahiro; Imai, Yutaka; Stolarz-Skrzypek, Katarzyna; Li, Yan; Wang, Ji -Guang; Casiglia, Edoardo; Malyutina, Sofia; Staessen, Jan
• Is Part Of: Journal of hypertension. Volume 39(2021)e-Supplement 1
• Publication Date: 2021-04
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000744392.65914.7d
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: The role of pulse pressure 'widening' at older age, as a cardiovascular risk factor is still controversial. 24-hour ambulatory pulse pressure (PP) was previously expressed as a sum of two components: 'elastic' PP (elPP) and 'stiffening' PP (stPP) associated, respectively, with arterial stiffness at diastole and the change in stiffness during systole. We investigated the association of PP, elPP and stPP ('PP variables') with mortality and composite cardiovascular (CV) events in different age classes. Design and method: Longitudinal population-based cohort study of adults from Europe, Asia, and South America with baseline observations, including 24-hour ambulatory BP. Age classes were age < 50, 50–60, 60–70, and > 70 year. Co-primary endpoints were total mortality and composite CV events. Hazard ratios (HRs) per 1-SD increase in the PP variables were calculated from multivariable adjusted Cox regression models. Results: The 11, 848 participants from 13 cohorts (age 53 ± 16, 50% males) were followed up for 13.4 ± 6.9 years. A total of 2946 participants died (18.1 per 1000 person-years) and 2093 experienced a fatal or non-fatal cardiovascular event (12.9 per 1000 person-years). PP components were uncorrelated (r = -0.07), and the ratio stPP/elPP was 0.143. PP and elPP showed a curvilinear relationship with age reaching a nadir around middle-age, whereas stPP steadily increased from age 30 years onwards. In persons ?50 years of age, but not in those < 50 years, both PP and elPP were associated with increased risk for the primary endpoints. For total mortality and cardiovascular events hazard ratios for PP decreased from 50–60 years old participants to those aged > 70 years (P < 0.02); from 1.29[95%CI: 1.13–1.46] to 1.11[1.05–1.15], and from 1.40[1.24–1.58] to 1.16[1.10–1.23], respectively, and for elPP for cardiovascular events; from 1.29[1.14–1.45] to 1.16[1.09–1.23]. On the other hand, stPP was associated with increased risk for the primary endpoints in subjects 50 to 60 years of age but not in the older age groups. Conclusions: The age-related increase in PP variables is not reflected in a corresponding PP-associated increase in cardiovascular risk. Results support the view that normal ageing weakens the association of PP variables with CV risk.