Pulse pressure strongly predicts cardiac death in women

20 November 2008

MedWire News: In women with suspected cardiovascular (CV) disease, brachial pulse pressure (PP) is a stronger predictor of poor outcome than other blood pressure (BP) components, study results demonstrate.

Reports have suggested that PP is a predictor of adverse CV outcomes, but the relative contribution of BP components has been unclear, especially in female patients.

Carl Pepine, from the University of Florida in Gainesville, USA, and colleagues investigated the relative contributions of brachial BP components to risk of adverse CV outcomes in 857 patients from the Women’s Ischemia Syndrome Evaluation cohort.

A total of 66 of the patients died of CV causes and another 160 women had an adverse CV outcome (nonfatal myocardial infarction, hospitalization for heart failure, and nonfatal stroke).

After adjusting for significant covariables, such as age, smoking, and diabetes, PP remained an independent predictor of CV mortality (hazard ratio [HR]=1.18) and adverse CV outcomes (HR=1.18).

Writing in the American Journal of Hypertension, the researchers report that for every 10-mmHg increase in PP there was an 18% excess mortality risk.

When PP and systolic (S)BP were included in the same models for analysis, only PP remained an independent predictor of adverse CV outcomes.

The researchers conclude: “PP, as opposed to SBP considered in isolation, provides a more complete picture of the BP-adverse outcome relationship. As a single representation of two risk factors (SBP and diastolic BP) PP may, therefore, be a stronger predictor of outcomes.”

They suggest: “Further investigations into pathophysiologic mechanisms and specific pharmacologic approaches to modifying this novel target are merited.”

Am J Hypertens 2008; 21: 1224–1230