Greater pulse pressure was associated with increased relative risk of MACE and mortality in adults ≥50 years (HR 1.09-1.54, P<0.0001), but inversely associated with MACE in young adults (HR 0.67).
Cohort (n=11,848)
Does 24-hour brachial pulse pressure predict total mortality and major cardiovascular events in young and older adults?
From age 50 onwards, higher pulse pressure is associated with increased absolute and relative cardiovascular risk, whereas in young adults it is not associated with increased absolute risk.
Estimación del efecto: HR 0.67 (95% CI 0.47-0.96)
valor p: p=≤0.027
BACKGROUND: Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan. METHODS: In 4,663 young (18-49 years) and 7,185 older adults (≥50 years), brachial PP was recorded over 24 hours. Total mortality and all major cardiovascular events (MACEs) combined were coprimary endpoints. Cardiovascular death, coronary events, and stroke were secondary endpoints. RESULTS: In young adults (median follow-up, 14.1 years; mean PP, 45.1 mm Hg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1,000 person-years. The adjusted hazard ratios expressed per 10-mm Hg PP increments were less than unity (P ≤ 0.027) for MACE (0.67; 95% confidence interval CI, 0.47-0.96) and cardiovascular death (0.33; 95% CI, 0.11-0.75). In older adults (median follow-up, 13.1 years; mean PP, 52.7 mm Hg), the endpoint rates, expressing absolute risk, ranged from 22.5 to 45.4 per 1,000 person-years and the adjusted hazard ratios, reflecting relative risk, from 1.09 to 1.54 (P 3-fold from age 55 to 75 years, whereas absolute risk rose by a factor 3. CONCLUSIONS: From 50 years onwards, the PP-related relative risk decreases, whereas absolute risk increases. From a lifecourse perspective, young adulthood provides a window of opportunity to manage risk factors and prevent target organ damage as forerunner of premature death and MACE. In older adults, treatment should address absolute risk, thereby extending life in years and quality.
Melgarejo et al. (Wed,) conducted a cohort in Cardiovascular risk (n=11,848). Pulse pressure was evaluated on Total mortality and all major cardiovascular events (MACEs) combined (HR 0.67, 95% CI 0.47-0.96, p=≤0.027). Greater pulse pressure was associated with increased relative risk of MACE and mortality in adults ≥50 years (HR 1.09-1.54, P<0.0001), but inversely associated with MACE in young adults (HR 0.67).