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Comparative Study
. 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

Mary J Roman  1 , Richard B Devereux, Jorge R Kizer, Peter M Okin, Elisa T Lee, Wenyu Wang, Jason G Umans, Darren Calhoun, Barbara V Howard
Affiliations
Comparative Study

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

Mary J Roman et al. J Am Coll Cardiol. .

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.

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Figures

Figure 1
Figure 1. Hazards Ratios for Incident Cardiovascular Event
Hazards ratios for incident cardiovascular events in 2,405 individuals initially free of clinical cardiovascular disease are stratified by quartiles of brachial (hatched bars) and central aortic (solid bars) PPs. Quartiles of central PP (p<0.001) predicted outcome more strongly than quartiles of brachial PP (p=0.052). Only the event rate in the fourth central PP quartile (PP ≥50 mmHg) was significantly higher than in the first quartile (p=0.003).
Figure 2
Figure 2. Box Plots of Brachial PP per Quartile of Central Aortic PP
Box plots (median, quartiles and range) of brachial PP stratified by quartile of central aortic PP demonstrate substantial overlap of brachial PP values across quartiles and highlight the inability to accurately estimate central pressure from brachial pressure.
See this image and copyright information in PMC

References

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