Document Detail


Pulse pressure and risk for myocardial infarction and heart failure in the elderly.
MedLine Citation:
PMID:  10898424     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to determine whether pulse pressure (PP), a measure of arterial stiffness, is an independent predictor of the incidence of coronary heart disease (CHD), congestive heart failure (CHF) and overall mortality among community-dwelling elderly. BACKGROUND: Current hypertension guidelines classify cardiovascular risk on the basis of elevated systolic blood pressure (SBP) or diastolic blood pressure (DBP) without considering their combined effects. Recent studies suggest that PP is a strong predictor of cardiovascular end points, but few data are available among community elderly. METHODS: The study sample included 2,152 individuals age > or =65 years, who were participants in the Established Populations for Epidemiologic Study of the Elderly program, free of CHD and CHF at baseline and still alive at one year after enrollment. Blood pressure was measured at baseline. Incidence of CHD, incidence of CHF and total mortality were monitored in the following 10 years. RESULTS: There were 328 incident CHD events, 224 incident CHF events and 1,046 persons who died of any cause. Pulse pressure showed a strong and linear relationship with each end point. After adjusting for demographics, comorbidity and CHD risk factors, a 10-mm Hg increment in PP was associated with a 12% increase in CHD risk (95% confidence interval [CI], 2% to 22%), a 14% increase in CHF risk (95% CI, 5% to 24%), and a 6% increase in overall mortality (95% CI, 0% to 12%). While SBP and mean arterial pressure (MAP) also showed positive associations with the end points, PP yielded the highest likelihood ratio chi-square. When PP was entered in the model in conjunction with other blood pressure parameters (SBP, DBP, MAP or hypertension stage, respectively), the association remained positive for PP but became negative for the other blood pressure variables. The effect of PP persisted after adjusting for current medication use and was present in normotensive individuals and individuals with isolated systolic hypertension but not in individuals with diastolic hypertension. CONCLUSIONS: Elevated PP is a powerful independent predictor of cardiovascular end points in the elderly.
Authors:
V Vaccarino; T R Holford; H M Krumholz
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  36     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-08-01     Completed Date:  2000-08-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  130-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520-8034, USA. viola.vaccarino@yale.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Blood Pressure*
Female
Heart Failure / epidemiology,  etiology,  physiopathology*
Humans
Hypertension / complications,  epidemiology,  physiopathology
Incidence
Male
Myocardial Contraction*
Myocardial Infarction / epidemiology,  etiology,  physiopathology*
Prognosis
Pulse
Retrospective Studies
Risk Factors
Survival Rate
Grant Support
ID/Acronym/Agency:
N01-AG-02105/AG/NIA NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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