Elevated pulse pressure and cardiovascular risk associated in Spanish population attended in primary care: IBERICAN study

Abstract

Introduction: Elevated pulse pressure (ePP) is an independent marker of cardiovascular risk (CVR) in people older than 60, and a functional marker of subclinical target organ damage (sTOD) which can predict cardiovascular events in patients with hypertension (HTN), regardless of sTOD.

Objective: To evaluate the prevalence of ePP in adult population seen in primary care and its association with other vascular risk factors, sTOD and with cardiovascular disease (CVD).

Materials and methods: Observational multicentre study conducted in Spain (8,066 patients, 54.5% women) from the prospective cohort study IBERICAN recruited in Primary Care. Pulse pressure (PP) was defined as the difference between the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) ≥60 mmHg. Adjusted (for age and sex) ePP prevalence were determined. Bivariate and multivariate analyses of the possible variables associated with ePP were carried out.

Results: The mean of PP was 52.35 mmHg, and was significantly higher (p < 0.001) in patients with HTN (56.58 vs. 48.45 mmHg) The prevalence of ePP adjusted for age and sex was 23.54% (25.40% men vs. 21.75% women; p < 0.0001). The ePP prevalence rates increased linearly with age (R² = 0.979) and were significantly more frequent in population aged ≥65 than in population aged <65 (45.47% vs. 20.98%; p < 0.001). HTN, left ventricular hypertrophy, low estimated glomerular filtration rate, alcohol consumption, abdominal obesity, and CVD were independently associated with ePP. 66.27% of patients with ePP had a high or very high CVR, as compared with 36.57% of patients without ePP (OR: 3.41 [95% CI 3.08-3.77]).

Conclusions: The ePP was present in a quarter of our sample, and it was increased with the age. Also, the ePP was more frequent in men, patients with HTN, other TOD (as left ventricular hypertrophy or low estimated glomerular filtration rate) and CVD; because of this, the ePP was associated a higher cardiovascular risk. In our opinion, the ePP is an importer risk marker and its early identification lets to improve better diagnostic and therapeutic management.

Keywords: cardiovascular disease; cardiovascular risk factors; hypertension; hypertensive cardiovascular disease; pulse pressure; subclinical target organ damage.

Figure 1

Linear correlation between prevalence of elevated pulse pressure (ePP ≥60 mmHg) and age of the IBERICAN cohort.

Figure 2

Forest Plot representation of associations between various factors and ePP in the IBERICAN cohort ePP, elevated pulse pressure; PP pulse pressure; TG/c-HDL, triglycerides/HDL-cholesterol; CVD FH, first-degree family history of premature cardiovascular disease [<55 years (men); <65 years(women)]; LVH, left ventricular hypertrophy; ABI, ankle-brachial index; albuminuria, low eGFR: glomerular filtration rate <60 ml/min/1.73 m² estimated according to CKD-EPI; albumin-creatinine ratio (ACR) 30 mg/g (including proteinuria: ACR > 300 mg/g); CKD, chronic kidney disease (low eGFR and/or albuminuria); sTOD, subclinical target organ damage (LVH, albuminuria, low e GER, ABI a0.9); PAD, peripheral artery disease, ABI ≤0.9; ACVD, atherosclerotic cardiovascular disease (coronary heart disease, stroke, heart failure, atrial fibrillation, PAD); CVD cardiovascular disease; CVR, cardiovascular risk according to SCORE. 95% CI: 95% confidence interval; p, p-value.