Document Detail

Pulse pressure amplification a mechanical biomarker of cardiovascular risk.
MedLine Citation:
PMID:  20202520     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of this study was to determine whether the carotid/brachial (C/B) ratio is an independent predictor of cardiovascular (CV) risk. BACKGROUND: Brachial and carotid pulse pressure (PP) are independent predictors of CV risk, mainly in elderly patients. Because PP is physiologically lower at the brachial than at the carotid arterial site, PP amplification is represented by the C/B ratio and could independently predict CV risk. METHODS: In a Paris population (n = 834), brachial and carotid PP were measured from sphygmomanometry and pulse wave analysis. With stepwise multiple regression, carotid PP was calculated from a nomogram including age, sex, body height, brachial PP, and plasma glucose. This model was applied to 125,151 subjects, followed for 12 years, during which 3,997 deaths occurred (735 of CV origin). With Cox regression analysis, multi-adjusted hazard ratios (HRs) were calculated for 1 SD increase of brachial PP, calculated carotid PP, and C/B ratio. RESULTS: Brachial PP was significantly associated with both CV and all-cause mortality (HR: 1.16, 95% confidence interval [CI]: 1.13 to 1.19, and HR: 1.13, 95% CI: 1.10 to 1.17, respectively). Calculated carotid PP predicted a similar risk (HR: 1.21, 95% CI: 1.15 to 1.28, and HR: 1.18, 95% CI: 1.12 to 1.25, respectively). Finally, the C/B ratio was a strong risk predictor (HR: 1.22, 95% CI: 1.12 to 1.32, and HR: 1.41, 95% CI: 1.14 to 1.73, respectively). Addition of drug treatment and other confounding variables did not statistically modify the results. CONCLUSIONS: Brachial PP, calculated carotid PP, and C/B PP amplification all predict CV mortality. In contrast to brachial and carotid PP, the C/B ratio is less dependent on blood pressure calibration and thus can be directly applicable to large population studies.
Athanase Benetos; Frédérique Thomas; Laure Joly; Jacques Blacher; Bruno Pannier; Carlos Labat; Paolo Salvi; Harold Smulyan; Michel E Safar
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  55     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-05     Completed Date:  2010-03-29     Revised Date:  2010-08-30    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1032-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Department of Geriatrics CHU de Nancy, and INSERM U691, University of Nancy, Nancy, France.
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MeSH Terms
Age Factors
Aged, 80 and over
Biological Markers / blood
Blood Glucose / metabolism
Blood Pressure / physiology*
Body Height
Brachial Artery / physiopathology*
Cardiovascular Diseases / diagnosis,  mortality,  physiopathology*
Carotid Arteries / physiopathology*
Cause of Death
Follow-Up Studies
Hypertension / diagnosis,  mortality,  physiopathology
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
Reference Values
Regression Analysis
Risk Assessment / statistics & numerical data
Sex Factors
Young Adult
Reg. No./Substance:
0/Biological Markers; 0/Blood Glucose
Comment In:
J Am Coll Cardiol. 2010 Mar 9;55(10):1038-40   [PMID:  20202521 ]
J Am Coll Cardiol. 2010 Aug 24;56(9):744; author reply 744-5   [PMID:  20723810 ]

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