BACKGROUND: Recent data suggest that brachial pulse pressure (PP) may be a better predictor of outcome than systolic or diastolic blood pressure (SBP/DBP). We sought to investigate the relative contributions of these indices to risk for adverse outcomes in women with suspected coronary artery disease (CAD) and myocardial ischemia. METHODS: Among 857 women referred for angiography for suspected myocardial ischemia, baseline evaluations were performed, and the women were followed for clinical outcome. Relationships between baseline characteristics, blood pressure components, and outcomes were evaluated. Separate multivariate stepwise Cox regression models for PP and SBP (expressed in 10 mm Hg increments) were constructed and included covariates significantly associated with adverse outcomes. RESULTS: After 5.2 years (mean), univariate testing identified higher PP associated with higher risk for cardiovascular (CV) mortality and adverse CV outcomes than SBP, DBP, or mean arterial pressure (MAP). Multivariate modeling identified both PP and SBP associated with adverse CV outcomes, but only PP was significantly associated with higher CV mortality. When both PP and SBP were included in the model, only PP remained an independent predictor of adverse outcomes for CV events. CONCLUSIONS: In women with suspected CAD and myocardial ischemia, PP is a stronger predictor of adverse outcomes than SBP, DBP, or MAP with an 18% excess mortality risk for every 10 mm Hg increase in PP. Further investigations into pathophysiologic mechanisms and specific pharmacologic approaches to modifying this novel target are warranted.
BACKGROUND: Recent data suggest that brachial pulse pressure (PP) may be a better predictor of outcome than systolic or diastolic blood pressure (SBP/DBP). We sought to investigate the relative contributions of these indices to risk for adverse outcomes in women with suspected coronary artery disease (CAD) and myocardial ischemia. METHODS: Among 857 women referred for angiography for suspected myocardial ischemia, baseline evaluations were performed, and the women were followed for clinical outcome. Relationships between baseline characteristics, blood pressure components, and outcomes were evaluated. Separate multivariate stepwise Cox regression models for PP and SBP (expressed in 10 mm Hg increments) were constructed and included covariates significantly associated with adverse outcomes. RESULTS: After 5.2 years (mean), univariate testing identified higher PP associated with higher risk for cardiovascular (CV) mortality and adverse CV outcomes than SBP, DBP, or mean arterial pressure (MAP). Multivariate modeling identified both PP and SBP associated with adverse CV outcomes, but only PP was significantly associated with higher CV mortality. When both PP and SBP were included in the model, only PP remained an independent predictor of adverse outcomes for CV events. CONCLUSIONS: In women with suspected CAD and myocardial ischemia, PP is a stronger predictor of adverse outcomes than SBP, DBP, or MAP with an 18% excess mortality risk for every 10 mm Hg increase in PP. Further investigations into pathophysiologic mechanisms and specific pharmacologic approaches to modifying this novel target are warranted.
Authors: Frej Fyhrquist; Björn Dahlöf; Richard B Devereux; Sverre E Kjeldsen; Stevo Julius; Gareth Beevers; Ulf de Faire; Hans Ibsen; Krister Kristianson; Ole Lederballe-Pedersen; Lars H Lindholm; Markku S Nieminen; Per Omvik; Suzanne Oparil; Darcy A Hille; Paulette A Lyle; Jonathan M Edelman; Steven M Snapinn; Hans Wedel Journal: Hypertension Date: 2005-04 Impact factor: 10.190
Authors: C N Merz; S F Kelsey; C J Pepine; N Reichek; S E Reis; W J Rogers; B L Sharaf; G Sopko Journal: J Am Coll Cardiol Date: 1999-05 Impact factor: 24.094
Authors: Bente K Kilhovd; Auni Juutilainen; Seppo Lehto; Tapani Rönnemaa; Peter A Torjesen; Kåre I Birkeland; Tore J Berg; Kristian F Hanssen; Markku Laakso Journal: Arterioscler Thromb Vasc Biol Date: 2005-02-03 Impact factor: 8.311
Authors: Wilmer W Nichols; Scott J Denardo; B Delia Johnson; Barry L Sharaf; C Noel Bairey Merz; Carl J Pepine Journal: J Hypertens Date: 2013-07 Impact factor: 4.844
Authors: Susan Cheng; Deepak K Gupta; Brian Claggett; A Richey Sharrett; Amil M Shah; Hicham Skali; Madoka Takeuchi; Hanyu Ni; Scott D Solomon Journal: Hypertension Date: 2013-07-22 Impact factor: 10.190