The contribution of mean arterial pressure to pulse pressure is greater in women than in men beginning before middle age

The study analyses the contribution of mean arterial pressure (MAP) to pulse pressure (PP) in hypertensive men and women younger than 50 years. Central pressure waveform was obtained from radial artery applanation tonometry in 312 hypertensive patients between 16 to 49 years (134 women, mean age 35 ± 9 years). As expected, brachial PP, central PP, incident wave, and augmentation pressure were significantly higher above the mean level of MAP (≥ 100 mmHg) compared to lower levels (p values adjusted for sex, age, height, weight, and heart rate were 0.001, < 0.001, 0.005, and < 0.001 respectively). In turn, the differences observed in brachial PP, central PP, and the incident wave between the MAP subgroups were significantly greater in women than in men (p values for the interaction between sex and MAP adjusted by age, height, weight, and heart rate were 0.008, 0.004 and 0.010 respectively). When subjects were stratified by age (16–29, 30–39, and 40–49 years), the strength of the relationship between MAP and central PP increased from age 30–39 onwards in women and from age 40–49 in men (p-value for the interaction between sex, MAP, and age group: < 0.001). The sex difference was driven by a greater MAP-mediated increase in the incident wave in women (p < 0.001). In conclusion, in hypertensive subjects younger than 50 years, the contribution of MAP to PP was greater in women than in men beginning at age 30–39 years.