Pulse Pressure and Risk for Cardiovascular Events in Patients With Atherothrombosis: From the REACH Registry

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• 作者：Senthil Selvaraj ; MD ; MA^a ; Ph. Gabriel Steg ; MD^b ; ^c ; ^d ; ^e ; Yedid Elbez ; MSc^b ; ^c ; ^d ; Emmanuel Sorbets ; MD^b ; ^c ; ^d ; ^f ; ^g ; Laurent J. Feldman ; MD^b ; ^c ; ^d ; Kim A. Eagle ; MD^h ; E. Magnus Ohman ; MDⁱ ; Jacques Blacher ; MD ; PhD^j ; Deepak L. Bhatt ; MD ; MPH^a ; ^{dlbhattmd@post.harvard.edu" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the REACH Registry Investigators
• 关键词：blood pressure ; diastolic blood pressure ; hypertension ; systolic blood pressure ; wave reflections
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：2 February 2016
• 年：2016
• 卷：67
• 期：4
• 页码：392-403
• 全文大小：639 K

文摘

Pulse pressure (PP) provides valuable prognostic information in specific populations, but few studies have assessed its value on cardiovascular outcomes in a broad, worldwide population.

Objectives

The aim of this study was to determine whether PP is associated with major adverse cardiovascular outcomes, independently of mean arterial pressure.

Methods

Participants from the international REACH (Reduction of Atherothrombosis for Continued Health) registry, which evaluates subjects with clinical atherothrombotic disease or risk factors for its development, were examined. Those with incomplete 4-year follow-up or PP data (final n = 45,087) were excluded. Univariate and multivariate regression analyses were performed to determine the association between PP and cardiovascular outcomes, including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, all myocardial infarction, all stroke, cardiovascular hospitalization, and a combined outcome. PP was analyzed as a continuous and categorical (i.e., by quartile) variable.

Results

The mean age of the cohort was 68 ± 10 years, 35% were women, and 81% were treated for hypertension. The mean blood pressure was 138 ± 19/79 ± 11 mm Hg, rendering a mean PP of 49 ± 16 mm Hg. On univariate analysis, increasing PP quartile was associated with worse outcomes (p < 0.05 for all comparisons). After adjusting for sex, age, current smoking status, history of hypercholesterolemia, history of diabetes, aspirin use, statin use, blood pressure medication use, and mean arterial pressure, PP quartile was still associated with all outcomes except all stroke and cardiovascular death (p < 0.05 for all comparisons). Analysis of PP as a continuous variable yielded similar results.

Conclusions

In an international cohort of high-risk subjects, PP, a readily available hemodynamic parameter, is associated with multiple adverse cardiovascular outcomes and provides prognostic utility beyond that of mean arterial pressure.