What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Cardiovascular and all-cause mortality in the general population (n=510456). Intervention: Elevated brachial pulse pressure (highest category) vs. Lowest brachial pulse pressure category. Primary outcome: Cardiovascular mortality (RR 1.80, 95% CI 1.49-2.17).

July 23, 2014Open Access

Brachial Pulse Pressure and Cardiovascular or All‐Cause Mortality in the General Population: A Meta‐Analysis of Prospective Observational Studies

Key Result

Elevated brachial pulse pressure increased the risk of cardiovascular mortality by 80% (RR 1.80) and all-cause mortality by 32% (RR 1.32) compared to the lowest pulse pressure category.

Study Design

Type

Meta-Analysis (n=510,456)

Structured PICO

Does wide brachial pulse pressure predict cardiovascular or all-cause mortality in the general population?

Population

14 prospective observational studies involving 510,456 participants from the general population

Intervention

Wide brachial pulse pressure (highest category or per 10 mm Hg increment)

Comparator

Lowest brachial pulse pressure category

Outcome

Cardiovascular mortality and all-cause mortalityhard clinical

Wide brachial pulse pressure is significantly associated with a greater risk of cardiovascular and all-cause mortality in the general population.

Main Result

Effect estimate: RR 1.80 (95% CI 1.49-2.17)

Limitations

Absence of standardization in study design, duration, outcome definition, and adjustment for variables across studies
Individual studies did not adjust for potential risk factors consistently, such as lack of adjustment for mean arterial pressure (MAP)
Brachial PP measurement was obtained at a single clinic visit in most studies
No standardization of BP measurement technique across the included studies
Use of baseline PP instead of PP during follow-up to estimate relative risk
Only articles published in English were selected, with most studies coming from European and American populations

Abstract

This study aimed to quantitatively evaluate the predictive value of brachial pulse pressure and cardiovascular or all-cause mortality in the general population based on prospective observational studies by conducting a meta-analysis. Only prospective observational studies investigating baseline brachial pulse pressure and cardiovascular or all-cause mortality risk were selected from PubMed and Embase databases until July 2013. Fourteen studies involving 510,456 participants were analyzed. Pooled risk ratio (RR) of cardiovascular and all-cause mortality for the highest vs lowest brachial pulse pressure category was 1.80 (95% confidence interval CI, 1.49-2.17) and 1.32 (95% CI, 1.23-1.41), respectively. Pooled RR of cardiovascular and all-cause mortality per 10 mm Hg pulse pressure increment was 1.13 (95% CI, 1.10-1.17) and 1.09 (95% CI, 1.07-1.11), respectively. Wide brachial pulse pressure is associated with greater risk of cardiovascular and all-cause mortality. However, more well-designed studies specifically on age and sex are needed to further confirm these findings.

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Cite This Study

Leilei et al. (Wed,) conducted a meta-analysis in Cardiovascular and all-cause mortality in the general population (n=510,456). Elevated brachial pulse pressure (highest category) vs. Lowest brachial pulse pressure category was evaluated on Cardiovascular mortality (RR 1.80, 95% CI 1.49-2.17). Elevated brachial pulse pressure increased the risk of cardiovascular mortality by 80% (RR 1.80) and all-cause mortality by 32% (RR 1.32) compared to the lowest pulse pressure category.

synapsesocial.com/papers/6a09def44b13cba7925174f0 https://doi.org/https://doi.org/10.1111/jch.12375

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