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Office pulse pressure (PP) is a predictor for cardiovascular (CV) events and mortality. Our aim was to evaluate ambulatory PP as a long-term risk factor in a random cohort of middle-aged participants. The Opera study took place in years 1991-1993, with a 24-h ambulatory blood pressure measurement (ABPM) performed to 900 participants. The end-points were non-fatal and fatal CV events, and deaths of all-causes. Follow-up period, until the first event or until the end of the year 2014, was 21.1 years (mean). Of 900 participants, 22.6% died (29.6% of men/15.6% of women, p<.001). A CV event was experienced by 208 participants (23.1%), 68.3% of them were male (p<.001). High nighttime ambulatory PP predicted independently CV mortality (hazard ratio [HR] 2.60; 95% confidence interval [CI 95%] 1.08-6.31, p=.034) and all-cause mortality in the whole population (HR 1.72; Cl 95% 1.06-2.78, p=.028). In males, both 24-h PP and nighttime PP associated with CV mortality and all-cause mortality (24-h PP HR for CV mortality 2.98; CI 95% 1.11-8.04, p=.031 and all-cause mortality HR 2.40; CI 95% 1.32-4.37, p=.004). Accordingly, nighttime PP; HR for CV mortality 3.13; CI 95% 1.14-8.56, p=.026, and for all-cause mortality HR 2.26; CI 95% 1.29-3.96, p=.004. Cox regression analyses were adjusted by sex, CV risk factors, and appropriate ambulatory mean systolic BP. In our study, high ambulatory nighttime PP was detected as a long-term risk factor for CV and all-cause mortality in middle-aged individuals.
Subject(s)
Cardiovascular Diseases , Hypertension , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Risk FactorsABSTRACT
Blood pressure (BP) changes and risk factors associated with pulse pressure (PP) increase in elderly people have rarely been studied using ambulatory blood pressure monitoring (ABPM). The aim is to evaluate 10-year ambulatory blood pressure (ABP) changes in older hypertensives, focusing on PP and its associations with mortality. An observational study was conducted on 119 consecutive older treated hypertensives evaluated at baseline (T0) and after 10 years (T1). Treatment adherence was carefully assessed. The authors considered clinical parameters at T1 only in survivors (n = 87). Patients with controlled ABP both at T0 and T1 were considered as having sustained BP control. Change in 24-hour PP between T0 and T1 (Δ24-hour PP) was considered for the analyses. Mean age at T0: 69.4 ± 3.7 years. Females: 57.5%. Significant decrease in 24-hour, daytime, and nighttime diastolic BP (all P < .05) coupled with an increase in 24-hour, daytime, and nighttime PP (all P < .05) were observed at T1. Sustained daytime BP control was associated with lower 24-hour PP increase than nonsustained daytime BP control (+2.23 ± 9.36 vs +7.79 ± 8.64 mm Hg; P = .037). The association between sustained daytime BP control and Δ24-hour PP remained significant even after adjusting for age, sex, and 24-hour PP at T0 (ß=0.39; P = .035). Both 24-hour systolic BP and 24-hour PP at T0 predicted mortality (adjusted HR 1.07, P = .001; adjusted HR 1.25, P < .001, respectively). After ROC comparison (P = .001), 24-hour PP better predicted mortality than 24-hour systolic BP. The data confirm how ABP control affects vascular aging leading to PP increase. Both ambulatory PP and systolic BP rather than diastolic BP predict mortality in older treated hypertensives.
Subject(s)
Antihypertensive Agents/therapeutic use , Blood Pressure/physiology , Hypertension/drug therapy , Hypertension/mortality , Aged , Aged, 80 and over , Antihypertensive Agents/pharmacology , Blood Pressure Monitoring, Ambulatory , Circadian Clocks , Female , Humans , Hypertension/physiopathology , Male , Prognosis , Survival Analysis , Treatment Adherence and ComplianceABSTRACT
Objective To evaluated the relationship of ambulatory pulse pressure and severity intracranial arterial stenosis. Methods 165 ischemic stroke patients with intracranial arterial stenosis were selected as stenosis group. And 142 patients with no obvious intracranial arterial stenosis were selected as control group. All patients were given ambulatory blood pressure monitoring. 24 h average systolic pressure ,diastolic pressure and ambulatory pulse pressure were measured. Results Ambulatory pulse pressure of stenosis group[(73.02 ± 10.86)mmHg]was significantly higher than that of control group[(59.63±12.96)mmHg,P<0.01]. Ambulatory pulse pressure of mod-erated stenosis group[(69.73±9.3)mmHg,P < 0.05]was significantly higher than that of control group[(59.63± 12.96)mmHg,P<0.01]. Ambulatory pulse pressure of severe stenosis group[(77.36±7.94)mmHg]was signifi-cantly higher than that of moderate stenosis group[(69.73±9.3)mmHg,P < 0.05]. The level of ambulatory pulse pressure was independent risk factors of intracranial arterial stenosis(OR value:1.092). Conclusions Ambulatory pulse pressure is significantly related to the severity of intracranial arterial stenosis and is an independent risk factor for intracranial arterial stenosis.
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Objective To evaluated the relationship of ambulatory pulse pressure and severity intracranial arterial stenosis. Methods 165 ischemic stroke patients with intracranial arterial stenosis were selected as stenosis group. And 142 patients with no obvious intracranial arterial stenosis were selected as control group. All patients were given ambulatory blood pressure monitoring. 24 h average systolic pressure ,diastolic pressure and ambulatory pulse pressure were measured. Results Ambulatory pulse pressure of stenosis group[(73.02 ± 10.86)mmHg]was significantly higher than that of control group[(59.63±12.96)mmHg,P<0.01]. Ambulatory pulse pressure of mod-erated stenosis group[(69.73±9.3)mmHg,P < 0.05]was significantly higher than that of control group[(59.63± 12.96)mmHg,P<0.01]. Ambulatory pulse pressure of severe stenosis group[(77.36±7.94)mmHg]was signifi-cantly higher than that of moderate stenosis group[(69.73±9.3)mmHg,P < 0.05]. The level of ambulatory pulse pressure was independent risk factors of intracranial arterial stenosis(OR value:1.092). Conclusions Ambulatory pulse pressure is significantly related to the severity of intracranial arterial stenosis and is an independent risk factor for intracranial arterial stenosis.
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Objective To assess the relationship between ambulatory pulse pressure (PP),pulse pressure indices (PPI) and the severity of cognitive function.Methods Sixty patients with severe,moderate,mild vascular cognitive impairment(VCI) as the research object,and forty healthy people as control group.All of the patients of ambulatory blood pressure were monitored.Results Severe VCI group of PP and PPI was significantly higher than moderate,mild VCI group and the control group (PP (mmHg):(59.10 ± 11.82,54.94 ± 10.86,50.28 ±8.33,45.54±9.22,P＜0.05),PPI:(0.61±0.08,0.53±0.06,0.44±0.05,0.37±0.03,P＜0.05),and the MMSE score was significantly lower than moderate,mild,and the control group(15.56±2.64,19.32±3.32,22.62±3.11,26.45±2.94,P＜0.05).Moderate VCI group of PP and PPI was significantly higher than the control group(P＜0.05).MMSE score was significantly lower than mild VCI and the control group(P＜0.05).Linear correlation analysis showed that PP and PPI was significantly negative related to MMSE score.Conclusion The increase of dynamic pulse pressure,pulse pressure index is associated with the damage of cognitive function.
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110 g/m~2 in woman) were 94 subjects and non-LVH group 146 subjects.Results The average levels of 24-hour pulse pressure,day time pulse pressure,night time pulse pressure and AOD were significantly different between patients with LVH and without LVH(P
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60 mm Hg (PP1 group) or 40 mm Hg≤PP≤60 mm Hg (PP2 group),1 mm Hg =0.133 kPa.Ambulatory blood pressure monitoring,the serum and urine ?_2-MG,urine mAlb,blood BUN and Cr were measured in both groups,the blood pressure,serum and urine ?_2-MG,urine mAlb,blood BUN and Cr were compared between two groups. Results Compared with PP2 group,the PP1 group showed higher levels of renal function indexes. Conclusion Renal damage is related with pulse pressure in senile essential hypertension.
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Objective To find out the relationship between ambulatory pulse pressure (24 h PP) and left ventricular hypertrophy (LVH) and the enlarged diameter of aortic root (AOD) in aged pati ents with essential hypertension.Methods 118 aged patients with essential hypertension we r e examined by ambulatory blood pressure (ABP) and echocardiography,the different index of ABP and left ventricular mass index (LVMI) and AOD were measured.The p atients were divided into group A (24 h PP≥60 mmHg) and group B (24 h PP
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Objective To explore the possibility of dynamic pulse pressure (DPP) being used to predict cardiovascular events in old men with normotension. Methods During May 1995 to September 2001, a 24h DPP monitoring was carried out on 858 old men with normotension (60-91 years old, BP60 mmHg, respectively. The first attack of cardiovascular event was recorded. Results In the 3 groups of subjects, the incidence of total cardiovascular events (100 persons per year) was 3.7, 5.8, and 9.1 respectively (log-rank test, P=0.000 9, 0.000 2, 0.000 0). After adjustment for the other risk factors including age, hypertension history, diabetes and previous cardiovascular disease, it has been found that the data of dynamic pulse pressure is of a significant value for predict cardiovascular events (P
