Key result
In middle-aged subjects with target-organ damage, an increment in pulse pressure was associated with a significantly greater risk of cardiovascular events (HR 1.70; 95% CI 1.31-2.21; P<0.01).
Why the study?
Does the addition of 24-hour ambulatory blood pressure and target-organ damage markers improve prediction of cardiovascular events in healthy middle-aged and older individuals?
Cohort (n=1,408)
Does the addition of 24-hour ambulatory blood pressure and target-organ damage markers improve prediction of cardiovascular events in healthy middle-aged and older individuals?
Effect estimate: HR 1.70 (95% CI 1.31-2.21)
p-value: p=<0.01
The presence of target-organ damage identifies middle-aged individuals who are particularly susceptible to the cardiovascular risks associated with increased pulse pressure and blood pressure variability.
May support TOD-based risk stratification for pulse pressure in middle-aged adults; leaves open whether ambulatory monitoring improves event prediction.
Markers of target-organ damage and 24-hour ambulatory blood pressure (BP) measurement improve cardiovascular risk stratification. The prevalence of target-organ damage and raised BP increases with aging. The study aim was to evaluate the impact of age and target-organ damage on the prognostic value of ambulatory BP. Markers of target-organ damage and ambulatory BP were measured in 1408 healthy people aged 41 or 51 (middle-aged group), and 61 or 71 (older group) years. The primary outcome was cardiovascular events after 16 years of follow-up, with data obtained from national registries. The prognostic value of BP was evaluated with Cox regression models, adjusted for traditional risk factors and target-organ damage, including left ventricular mass, pulse wave velocity, carotid plaques, and urine albumin/creatinine ratio. A total of 323 events were observed. In comparison with traditional risk factors, adding systolic BP and presence of target-organ damage improved risk stratification by increasing concordance index from 0.711 to 0.728 ( P =0.01). In middle-aged subjects with target-organ damage, increment in pulse pressure (hazard ratio, 1.70; 95% confidence interval, 1.31–2.21; P <0.01) and increment in average real variability (hazard ratio, 1.29; 95% confidence interval, 1.05–1.59; P =0.02) were associated with a greater risk of cardiovascular disease compared with subjects without target-organ damage: hazard ratio, 1.04 (95% confidence interval, 0.74–1.46; P =0.81); P for interaction, 0.02; and hazard ratio, 0.89 (95% confidence interval, 0.69–1.14; P =0.36); P for interaction, 0.01. Target-organ damage may be a marker of individual susceptibility to the harmful effects of pulse pressure and BP variability on the cardiovascular system in middle-aged individuals.
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Olesen et al. (2017) conducted a cohort in Healthy people (n=1,408). 24-hour ambulatory blood pressure monitoring vs. Subjects without target-organ damage was evaluated on Cardiovascular events (HR 1.70, 95% CI 1.31-2.21, p=<0.01). In middle-aged subjects with target-organ damage, an increment in pulse pressure was associated with a significantly greater risk of cardiovascular events (HR 1.70; 95% CI 1.31-2.21; P<0.01).
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