Outcome-driven thresholds for ambulatory pulse pressure in 9938 participants recruited from 11 populations

Yu Mei Gu, Lutgarde Thijs, Yan Li, Kei Asayama, José Boggia, Tine W. Hansen, Yan Ping Liu, Takayoshi Ohkubo, Kristina Björklund-Bodegård, Jørgen Jeppesen, Eamon Dolan, Christian Torp-Pedersen, Tatiana Kuznetsova, Katarzyna Stolarz-Skrzypek, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars Lind, Edgardo SandoyaKalina Kawecka-Jaszcz, Yutaka Imai, Luis J. Mena, Jiguang Wang, Eoin O'Brien, Peter Verhamme, Jan Filipovský, Gladys E. Maestre, Jan A. Staessen

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)

Abstract

Evidence-based thresholds for risk stratification based on pulse pressure (PP) are currently unavailable. To derive outcome-driven thresholds for the 24-hour ambulatory PP, we analyzed 9938 participants randomly recruited from 11 populations (47.3% women). After age stratification (<60 versus ≥60 years) and using average risk as reference, we computed multivariable-adjusted hazard ratios (HRs) to assess risk by tenths of the PP distribution or risk associated with stepwise increasing (+1 mm Hg) PP levels. All adjustments included mean arterial pressure. Among 6028 younger participants (68 853 person-years), the risk of cardiovascular (HR, 1.58; P=0.011) or cardiac (HR, 1.52; P=0.056) events increased only in the top PP tenth (mean, 60.6 mm Hg). Using stepwise increasing PP levels, the lower boundary of the 95% confidence interval of the successive thresholds did not cross unity. Among 3910 older participants (39 923 person-years), risk increased (P≤0.028) in the top PP tenth (mean, 76.1 mm Hg). HRs were 1.30 and 1.62 for total and cardiovascular mortality, and 1.52, 1.69, and 1.40 for all cardiovascular, cardiac, and cerebrovascular events. The lower boundary of the 95% confidence interval of the HRs associated with stepwise increasing PP levels crossed unity at 64 mm Hg. While accounting for all covariables, the top tenth of PP contributed less than 0.3% (generalized R statistic) to the overall risk among the elderly. Thus, in randomly recruited people, ambulatory PP does not add to risk stratification below age 60; in the elderly, PP is a weak risk factor with levels below 64 mm Hg probably being innocuous.

Original languageEnglish
Pages (from-to)229-237
Number of pages9
JournalHypertension
Volume63
Issue number2
DOIs
Publication statusPublished - 2014 Feb

Keywords

  • ambulatory blood pressure
  • epidemiology
  • population science
  • pulse pressure

ASJC Scopus subject areas

  • Internal Medicine

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