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Pulse pressure is an independent predictor of microalbuminuria in non diabetic males
ORALS: Theme III: New Risk Factors in Cardiovascular Disease
COMBINED EFFECT OF PULSE PRESSURE AND HEART RATE ON CARDIOVASCULAR RISK F. Thomas K. Bean, J.F. Morcet, A. Dubanchet, L. Guize, -> A. Benetos. Centre d’hwestigafions PrCventives et Cliniques (IPC), Paris, France. In the present study, we examined the combined effect of pulse pressure (PP) and heart rate (HR) on cardiovascular (CVD) mortality. The present analysis concerned 125,513 me” aged from 20 to 95 years, who had a routme me&al examnatIon at the IPC Center between 1978 and 1988. Three groups of age were considered for this analysis : young (~50 yrs), mIddIe (5 l65 yrs), older (>65 yrs). PP was classified in 3 groups: 550, Sl65, 265 mmHg; HR m 4 groups: ~60, 60-80, 80-100 and >lOO beats/m”. In each age group, SubJeCtS with PP550 mmHg and HR ~60 beat&n made up the reference group (RG). After adJustment for age, cholesterol, and tobacco consumption, the relative risks (RR) for cardiovascular mortahty were calculated and are presented m the followmg tables: PPWR ~60 60-80 80-100 >lOO ~50 RG 1.5 2.3 3.4 Young 51-65 I.6 2.4 3.6 5.3 (n=93,791) 2.5 3.8 5.7 8.5 265
RG 1.5 2.4
1.3 2.0 3.1
t.7 2.1 4.1
2.3 3.5 5.3
Middle (n=29,417)
<50 51-65 ~65
RC 1.2 I.5
1.3 I.6 2.0
I.8 2.1 2.6
2.3 2.8 3.3
Older (n=2305)
These results show that PP and HR had an ad&we effect on CVD mortality This 1s observed m all age groups, though the RR are higher I” younger than in older SubJects. The combination of elevated PP and HR greatly increased cardiovascular risk. Key Words: Cardiovascular mortality, Heart rate, pulse presssure
PULSE PRESSURE IS AN INDEPENDENT PREDICTOR OF MICROALBUMINURIA IN NON DIABETIC MALES R.Pedrinelli’. V. Di Belle*, G. Dell’Omo’, D. Giorg?, S. Bandinell?, G. Penn07 M. Mariani’. Dipattimento di Cardiologia, Angiologia, Pneumologia’, Medicina Interna’ 8 Malattie del Metabolismo3, UniversitA di Pisa, Pisa. Italy Microalbuminuda (MA) . ,.(urinarv albumin excretion. UAE. between 20 and 200 pglmin) predicts cardiovascular morbidity in non diabetic subiects. but the reasons for this behavior are unknown. To evaluate this* asp&t in greater detail, UAE (by nephelometry in triplicated overnight collections), sphygmomanometric BP and several other cardiovascular and metabolic parameters, were evaluated in 180 132 83 uncomplicated stage l-3 essential normal controls, hypertensive& 65 atherosclerotic patients wlh clinically stable peripheral vascular disease (PVD) either hypertensive (n=48), or not (n=17)j untreated, non diabetic male subjects with normal cardiac and renal function. MA was found in 43 subjects characterized by elevated pulse pressure (PP. SBP-DBP, 70fl7 vs 58f15 mmHg, p~O.00001) since SBP was higher (164QO vs 151+20 mmHg, p
AJH
1999;12:12A-13A
PULSEPRESSURE - NOT MEAN PRESSURE - DETERMINES CARDIOVASCULAR RISK IN OLDER HYPERTENSIVE PATIENTS. J Gasowski, J Elacher. JA Steess-en,X Girerd, L Thijs,L Uu, JG Wang, RHFagard,ME Safar.Hypertension Unit, University of Leuvan, Belgium. Current guidelines for the managment of hypertension rest almost completely on the measurement of systolicand diastolicMood pressure; However, the arterial blood pressure wave is more correctly desaibed as consistingof a pulsatile (pulse pressure) and a steady component (mean pressure). This study explored the independent roles of pulse pressure end mean pressure as determinantsof cardiovascularprognosis in older hypertensive patients. This mete-analysis, based on individualpatient data, pooled lhe results of the trial conducted by the European Working Parly on High Blood Pressure in the Elderly (n=340), the Systolic Hypertension in Europe Trial (n=4695) and the Systolic Hypertensionin China Trial (n=2394). The relative hazard rates essodatad with pulse pressure and mean pressure were calculated, Using COXregression with Stratificationfor the three trial8 and Withadjustments for sex, age, pretius cardiovascularmmpliitions. smoking and treatment group. A IO mm Hg wider pulse pressure increased the risk of major cardiovascular complications;afler controllingfci mean pressure end the other ccvariates, the increase in risk ranged from approximately 13% for all corenary endpoint8 (P=O.O2)lo nearly 20% fw cardiovaswlar mortality (P=O.oOl). In a similar analysis, mean pressure predicted the incidenceof cardiovascularcomplications,but only after removal of pulse pressure as explanaioty Variable from the model. More&‘er. the probabilityof 8 major cardiovascularendoint inueesed with higher systolii blood pressure, and at any given level of systolicblood pressure, also rose with lower diastolic blood pressure, suggestingthat indeed the wider pulse pressure was driving the risk Of major OJmpli&JnS. In older hypetien8iVepatients pulse pressure - not mean pressure - is the major determinant of cardiovascularrisk. The implicationsof these finding8 for the management of hypertensivepatients should be subject tc further investigationin randomized controlledwtcome trials, in which the pulsatile component of blood pressure is differentlyinfluenced by antihypertensive drug treatment. Key Words:
elderly. hypertension,mean pressure, prognosis, pulse pressure
PULSE PRESSURE: A PREDICTOR OF CARDIOVASCULAR MORTALITY AMONG YOUNG NORMOTENSIVE SUBJECTS JJJ&g. S Madbwan, M H Alderman*, Albert Einstein College of Medicine, Bronx, New York Wide pulse pressure has been associated with increased cardiovascular eveats in hypertensivepatients, and normotensive middle-aged males. To furtherexplore the association of pulse pressure to all-zause and cardiovascularmortality in a representativenormotensive population, we analyzed data from the first National Health and Nutrition ExaminationSurvey, and Epidemiologic Follow-up Study. Baseline data were coIlacted from 1971 to 1975, and mortality data through 1992. The shuly group included 7346 pmticipants with baseline blood pressure < 140/90 mm Hg, and without history of hypertension. Mean age was 43.4 years and mean blood pressure 118/76 mm Hg, with an average pulse.pressure of 42 mm Hg and a mean arterial pressure of 90 mm Hg. During 17.4 years average follow-up, there were 1443 (19.6%) deaths, of which. 577 were ascribed to cardiovasculardisease.Age-race-adjustedcardiovascular mortality rates per lDo0 person-yearsby quartile of pulse pressurewere 3.49, 2.55. 3.39 and 4.75 for me” and 1.62, 1.78, 1.74 and 2.43 for women (P
COMBINED EFFECT OF PULSE PRESSURE AND HEART RATE ON CARDIOVASCULAR RISK F. Thomas K. Bean, J.F. Morcet, A. Dubanchet, L. Guize, -> A. Benetos. Centre d’hwestigafions PrCventives et Cliniques (IPC), Paris, France. In the present study, we examined the combined effect of pulse pressure (PP) and heart rate (HR) on cardiovascular (CVD) mortality. The present analysis concerned 125,513 me” aged from 20 to 95 years, who had a routme me&al examnatIon at the IPC Center between 1978 and 1988. Three groups of age were considered for this analysis : young (~50 yrs), mIddIe (5 l65 yrs), older (>65 yrs). PP was classified in 3 groups: 550, Sl65, 265 mmHg; HR m 4 groups: ~60, 60-80, 80-100 and >lOO beats/m”. In each age group, SubJeCtS with PP550 mmHg and HR ~60 beat&n made up the reference group (RG). After adJustment for age, cholesterol, and tobacco consumption, the relative risks (RR) for cardiovascular mortahty were calculated and are presented m the followmg tables: PPWR ~60 60-80 80-100 >lOO ~50 RG 1.5 2.3 3.4 Young 51-65 I.6 2.4 3.6 5.3 (n=93,791) 2.5 3.8 5.7 8.5 265
RG 1.5 2.4
1.3 2.0 3.1
t.7 2.1 4.1
2.3 3.5 5.3
Middle (n=29,417)
<50 51-65 ~65
RC 1.2 I.5
1.3 I.6 2.0
I.8 2.1 2.6
2.3 2.8 3.3
Older (n=2305)
These results show that PP and HR had an ad&we effect on CVD mortality This 1s observed m all age groups, though the RR are higher I” younger than in older SubJects. The combination of elevated PP and HR greatly increased cardiovascular risk. Key Words: Cardiovascular mortality, Heart rate, pulse presssure
PULSE PRESSURE IS AN INDEPENDENT PREDICTOR OF MICROALBUMINURIA IN NON DIABETIC MALES R.Pedrinelli’. V. Di Belle*, G. Dell’Omo’, D. Giorg?, S. Bandinell?, G. Penn07 M. Mariani’. Dipattimento di Cardiologia, Angiologia, Pneumologia’, Medicina Interna’ 8 Malattie del Metabolismo3, UniversitA di Pisa, Pisa. Italy Microalbuminuda (MA) . ,.(urinarv albumin excretion. UAE. between 20 and 200 pglmin) predicts cardiovascular morbidity in non diabetic subiects. but the reasons for this behavior are unknown. To evaluate this* asp&t in greater detail, UAE (by nephelometry in triplicated overnight collections), sphygmomanometric BP and several other cardiovascular and metabolic parameters, were evaluated in 180 132 83 uncomplicated stage l-3 essential normal controls, hypertensive& 65 atherosclerotic patients wlh clinically stable peripheral vascular disease (PVD) either hypertensive (n=48), or not (n=17)j untreated, non diabetic male subjects with normal cardiac and renal function. MA was found in 43 subjects characterized by elevated pulse pressure (PP. SBP-DBP, 70fl7 vs 58f15 mmHg, p~O.00001) since SBP was higher (164QO vs 151+20 mmHg, p
AJH
1999;12:12A-13A
PULSEPRESSURE - NOT MEAN PRESSURE - DETERMINES CARDIOVASCULAR RISK IN OLDER HYPERTENSIVE PATIENTS. J Gasowski, J Elacher. JA Steess-en,X Girerd, L Thijs,L Uu, JG Wang, RHFagard,ME Safar.Hypertension Unit, University of Leuvan, Belgium. Current guidelines for the managment of hypertension rest almost completely on the measurement of systolicand diastolicMood pressure; However, the arterial blood pressure wave is more correctly desaibed as consistingof a pulsatile (pulse pressure) and a steady component (mean pressure). This study explored the independent roles of pulse pressure end mean pressure as determinantsof cardiovascularprognosis in older hypertensive patients. This mete-analysis, based on individualpatient data, pooled lhe results of the trial conducted by the European Working Parly on High Blood Pressure in the Elderly (n=340), the Systolic Hypertension in Europe Trial (n=4695) and the Systolic Hypertensionin China Trial (n=2394). The relative hazard rates essodatad with pulse pressure and mean pressure were calculated, Using COXregression with Stratificationfor the three trial8 and Withadjustments for sex, age, pretius cardiovascularmmpliitions. smoking and treatment group. A IO mm Hg wider pulse pressure increased the risk of major cardiovascular complications;afler controllingfci mean pressure end the other ccvariates, the increase in risk ranged from approximately 13% for all corenary endpoint8 (P=O.O2)lo nearly 20% fw cardiovaswlar mortality (P=O.oOl). In a similar analysis, mean pressure predicted the incidenceof cardiovascularcomplications,but only after removal of pulse pressure as explanaioty Variable from the model. More&‘er. the probabilityof 8 major cardiovascularendoint inueesed with higher systolii blood pressure, and at any given level of systolicblood pressure, also rose with lower diastolic blood pressure, suggestingthat indeed the wider pulse pressure was driving the risk Of major OJmpli&JnS. In older hypetien8iVepatients pulse pressure - not mean pressure - is the major determinant of cardiovascularrisk. The implicationsof these finding8 for the management of hypertensivepatients should be subject tc further investigationin randomized controlledwtcome trials, in which the pulsatile component of blood pressure is differentlyinfluenced by antihypertensive drug treatment. Key Words:
elderly. hypertension,mean pressure, prognosis, pulse pressure
PULSE PRESSURE: A PREDICTOR OF CARDIOVASCULAR MORTALITY AMONG YOUNG NORMOTENSIVE SUBJECTS JJJ&g. S Madbwan, M H Alderman*, Albert Einstein College of Medicine, Bronx, New York Wide pulse pressure has been associated with increased cardiovascular eveats in hypertensivepatients, and normotensive middle-aged males. To furtherexplore the association of pulse pressure to all-zause and cardiovascularmortality in a representativenormotensive population, we analyzed data from the first National Health and Nutrition ExaminationSurvey, and Epidemiologic Follow-up Study. Baseline data were coIlacted from 1971 to 1975, and mortality data through 1992. The shuly group included 7346 pmticipants with baseline blood pressure < 140/90 mm Hg, and without history of hypertension. Mean age was 43.4 years and mean blood pressure 118/76 mm Hg, with an average pulse.pressure of 42 mm Hg and a mean arterial pressure of 90 mm Hg. During 17.4 years average follow-up, there were 1443 (19.6%) deaths, of which. 577 were ascribed to cardiovasculardisease.Age-race-adjustedcardiovascular mortality rates per lDo0 person-yearsby quartile of pulse pressurewere 3.49, 2.55. 3.39 and 4.75 for me” and 1.62, 1.78, 1.74 and 2.43 for women (P