OBJECTIVE: Although current guidelines rest exclusively on the measurement of systolic and diastolic blood pressures, the arterial pressure wave is more precisely described as consisting of a pulsatile (pulse pressure) and a steady (mean pressure) component. This study explored the independent roles of pulse pressure and mean pressure as predictors of mortality in a wide range of patients with hypertension. DESIGN AND METHODS: This meta-analysis, based on individual patient data, has combined results from the control groups of seven randomized clinical trials conducted in patients with systolo-diastolic or isolated systolic hypertension. The relative hazard rates associated with pulse pressure and mean pressure were calculated using Cox's proportional hazard regression models with stratification for the seven trials and with adjustment for sex, age, smoking and the other pressure. RESULTS: A 10 mmHg wider pulse pressure at baseline, which corresponds to approximately one-half of its standard deviation, was independently associated with an increase in risk by 6% for total mortality (P = 0.001), 7% for cardiovascular mortality (P = 0.01), and 7% for fatal coronary accidents (P = 0.03). The corresponding increase in risk of fatal stroke was similar (+6%, P = 0.27) but there were too few strokes to reach statistical significance. In similar analyses, mean pressure was not identified as an independent predictor of these outcomes. Significant interactions of pulse pressure or mean pressure with age suggested that the prognostic power of pulse pressure for fatal stroke was more important at higher age (P = 0.04), whereas the prognostic power of mean pressure for coronary mortality was greatest in the young (P = 0.01). CONCLUSIONS: In hypertensive patients pulse pressure, not mean pressure, is associated with an increased risk of fatal events. This appears to be true in a broad range of patients with hypertension.
RCT Entities:
OBJECTIVE: Although current guidelines rest exclusively on the measurement of systolic and diastolic blood pressures, the arterial pressure wave is more precisely described as consisting of a pulsatile (pulse pressure) and a steady (mean pressure) component. This study explored the independent roles of pulse pressure and mean pressure as predictors of mortality in a wide range of patients with hypertension. DESIGN AND METHODS: This meta-analysis, based on individual patient data, has combined results from the control groups of seven randomized clinical trials conducted in patients with systolo-diastolic or isolated systolic hypertension. The relative hazard rates associated with pulse pressure and mean pressure were calculated using Cox's proportional hazard regression models with stratification for the seven trials and with adjustment for sex, age, smoking and the other pressure. RESULTS: A 10 mmHg wider pulse pressure at baseline, which corresponds to approximately one-half of its standard deviation, was independently associated with an increase in risk by 6% for total mortality (P = 0.001), 7% for cardiovascular mortality (P = 0.01), and 7% for fatal coronary accidents (P = 0.03). The corresponding increase in risk of fatal stroke was similar (+6%, P = 0.27) but there were too few strokes to reach statistical significance. In similar analyses, mean pressure was not identified as an independent predictor of these outcomes. Significant interactions of pulse pressure or mean pressure with age suggested that the prognostic power of pulse pressure for fatal stroke was more important at higher age (P = 0.04), whereas the prognostic power of mean pressure for coronary mortality was greatest in the young (P = 0.01). CONCLUSIONS: In hypertensivepatients pulse pressure, not mean pressure, is associated with an increased risk of fatal events. This appears to be true in a broad range of patients with hypertension.
Authors: Csaba P Kovesdy; Anthony J Bleyer; Miklos Z Molnar; Jennie Z Ma; John J Sim; William C Cushman; L Darryl Quarles; Kamyar Kalantar-Zadeh Journal: Ann Intern Med Date: 2013-08-20 Impact factor: 25.391
Authors: Yun Ju Sung; Lisa de Las Fuentes; Thomas W Winkler; Daniel I Chasman; Amy R Bentley; Aldi T Kraja; Ioanna Ntalla; Helen R Warren; Xiuqing Guo; Karen Schwander; Alisa K Manning; Michael R Brown; Hugues Aschard; Mary F Feitosa; Nora Franceschini; Yingchang Lu; Ching-Yu Cheng; Xueling Sim; Dina Vojinovic; Jonathan Marten; Solomon K Musani; Tuomas O Kilpeläinen; Melissa A Richard; Stella Aslibekyan; Traci M Bartz; Rajkumar Dorajoo; Changwei Li; Yongmei Liu; Tuomo Rankinen; Albert Vernon Smith; Salman M Tajuddin; Bamidele O Tayo; Wei Zhao; Yanhua Zhou; Nana Matoba; Tamar Sofer; Maris Alver; Marzyeh Amini; Mathilde Boissel; Jin Fang Chai; Xu Chen; Jasmin Divers; Ilaria Gandin; Chuan Gao; Franco Giulianini; Anuj Goel; Sarah E Harris; Fernando P Hartwig; Meian He; Andrea R V R Horimoto; Fang-Chi Hsu; Anne U Jackson; Candace M Kammerer; Anuradhani Kasturiratne; Pirjo Komulainen; Brigitte Kühnel; Karin Leander; Wen-Jane Lee; Keng-Hung Lin; Jian'an Luan; Leo-Pekka Lyytikäinen; Colin A McKenzie; Christopher P Nelson; Raymond Noordam; Robert A Scott; Wayne H H Sheu; Alena Stančáková; Fumihiko Takeuchi; Peter J van der Most; Tibor V Varga; Robert J Waken; Heming Wang; Yajuan Wang; Erin B Ware; Stefan Weiss; Wanqing Wen; Lisa R Yanek; Weihua Zhang; Jing Hua Zhao; Saima Afaq; Tamuno Alfred; Najaf Amin; Dan E Arking; Tin Aung; R Graham Barr; Lawrence F Bielak; Eric Boerwinkle; Erwin P Bottinger; Peter S Braund; Jennifer A Brody; Ulrich Broeckel; Brian Cade; Archie Campbell; Mickaël Canouil; Aravinda Chakravarti; Massimiliano Cocca; Francis S Collins; John M Connell; Renée de Mutsert; H Janaka de Silva; Marcus Dörr; Qing Duan; Charles B Eaton; Georg Ehret; Evangelos Evangelou; Jessica D Faul; Nita G Forouhi; Oscar H Franco; Yechiel Friedlander; He Gao; Bruna Gigante; C Charles Gu; Preeti Gupta; Saskia P Hagenaars; Tamara B Harris; Jiang He; Sami Heikkinen; Chew-Kiat Heng; Albert Hofman; Barbara V Howard; Steven C Hunt; Marguerite R Irvin; Yucheng Jia; Tomohiro Katsuya; Joel Kaufman; Nicola D Kerrison; Chiea Chuen Khor; Woon-Puay Koh; Heikki A Koistinen; Charles B Kooperberg; Jose E Krieger; Michiaki Kubo; Zoltan Kutalik; Johanna Kuusisto; Timo A Lakka; Carl D Langefeld; Claudia Langenberg; Lenore J Launer; Joseph H Lee; Benjamin Lehne; Daniel Levy; Cora E Lewis; Yize Li; Sing Hui Lim; Ching-Ti Liu; Jianjun Liu; Jingmin Liu; Yeheng Liu; Marie Loh; Kurt K Lohman; Tin Louie; Reedik Mägi; Koichi Matsuda; Thomas Meitinger; Andres Metspalu; Lili Milani; Yukihide Momozawa; Thomas H Mosley; Mike A Nalls; Ubaydah Nasri; Jeff R O'Connell; Adesola Ogunniyi; Walter R Palmas; Nicholette D Palmer; James S Pankow; Nancy L Pedersen; Annette Peters; Patricia A Peyser; Ozren Polasek; David Porteous; Olli T Raitakari; Frida Renström; Treva K Rice; Paul M Ridker; Antonietta Robino; Jennifer G Robinson; Lynda M Rose; Igor Rudan; Charumathi Sabanayagam; Babatunde L Salako; Kevin Sandow; Carsten O Schmidt; Pamela J Schreiner; William R Scott; Peter Sever; Mario Sims; Colleen M Sitlani; Blair H Smith; Jennifer A Smith; Harold Snieder; John M Starr; Konstantin Strauch; Hua Tang; Kent D Taylor; Yik Ying Teo; Yih Chung Tham; André G Uitterlinden; Melanie Waldenberger; Lihua Wang; Ya Xing Wang; Wen Bin Wei; Gregory Wilson; Mary K Wojczynski; Yong-Bing Xiang; Jie Yao; Jian-Min Yuan; Alan B Zonderman; Diane M Becker; Michael Boehnke; Donald W Bowden; John C Chambers; Yii-Der Ida Chen; David R Weir; Ulf de Faire; Ian J Deary; Tõnu Esko; Martin Farrall; Terrence Forrester; Barry I Freedman; Philippe Froguel; Paolo Gasparini; Christian Gieger; Bernardo Lessa Horta; Yi-Jen Hung; Jost Bruno Jonas; Norihiro Kato; Jaspal S Kooner; Markku Laakso; Terho Lehtimäki; Kae-Woei Liang; Patrik K E Magnusson; Albertine J Oldehinkel; Alexandre C Pereira; Thomas Perls; Rainer Rauramaa; Susan Redline; Rainer Rettig; Nilesh J Samani; James Scott; Xiao-Ou Shu; Pim van der Harst; Lynne E Wagenknecht; Nicholas J Wareham; Hugh Watkins; Ananda R Wickremasinghe; Tangchun Wu; Yoichiro Kamatani; Cathy C Laurie; Claude Bouchard; Richard S Cooper; Michele K Evans; Vilmundur Gudnason; James Hixson; Sharon L R Kardia; Stephen B Kritchevsky; Bruce M Psaty; Rob M van Dam; Donna K Arnett; Dennis O Mook-Kanamori; Myriam Fornage; Ervin R Fox; Caroline Hayward; Cornelia M van Duijn; E Shyong Tai; Tien Yin Wong; Ruth J F Loos; Alex P Reiner; Charles N Rotimi; Laura J Bierut; Xiaofeng Zhu; L Adrienne Cupples; Michael A Province; Jerome I Rotter; Paul W Franks; Kenneth Rice; Paul Elliott; Mark J Caulfield; W James Gauderman; Patricia B Munroe; Dabeeru C Rao; Alanna C Morrison Journal: Hum Mol Genet Date: 2019-08-01 Impact factor: 6.150