A 10 mm Hg increase in pulse pressure was independently associated with a 26% increased risk of cardiovascular death in persons aged 25-45 and a 10% increased risk in those aged 46-77.
Cohort (n=5,771)
Yes
Does elevated pulse pressure increase the risk of death from cardiovascular disease, coronary heart disease, and all-cause mortality in a US population free of overt cardiovascular disease?
Elevated pulse pressure provides independent prognostic information for cardiovascular and all-cause mortality beyond standard risk factors in a general US population.
Effect estimate: 26% increase in risk (age 25-45), 10% increase (age 46-77) (95% CI 5-50 (age 25-45), 2-19 (age 46-77))
Increased stiffness of the conduit arteries has been associated with increased risk of death and cardiovascular death in a number of populations. None of these populations, however, are fully representative of the US population. The cohort examined in the First National Health and Nutrition Examination Survey (NHANES I) that was free of overt cardiovascular disease was selected to be representative of the US population. We assessed and quantified the increased risk of death associated with elevated pulse pressure in this population. A cohort of 5771 subjects from NHANES I was used to determine the value of adding pulse pressure to standard cardiovascular disease risk factors for assessment of the risk of death during a mean follow-up period of 16.5 years. Analyses were performed by use of the SUDAAN statistical package for performing Cox proportional regression, logistic regression, and other standard methods in complex, weighted samples. Pulse pressure increased with increasing age, body mass index, cholesterol level, and mean arterial pressure. With increasing pulse pressure, the percentage of cigarette smokers decreased and the percentage of diabetics increased. Despite these associations with known risk factors, pulse pressure was independently predictive of an increased risk of death from cardiovascular disease, coronary heart disease, and all-cause mortality. It provides independent prognostic information beyond that provided by known risk factors that were evaluated in this study, including the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure hypertension classification. A 10 mm Hg increase in pulse pressure in persons 25 to 45 of age was associated with a 26% increase in risk of cardiovascular death (95% confidence interval CI, 5 to 50) and with an 10% increase (95% CI, 2 to 19) in persons 46 to 77 years of age. In a cohort designed to be representative of the US population, elevated pulse pressure has been shown to provide independent prognostic information. This variable may be a marker for the extent of vascular disease and may contribute to the occurrence of clinical events.
Domanski et al. (2001) conducted a cohort in Free of overt cardiovascular disease (n=5,771). Elevated pulse pressure vs. Standard cardiovascular disease risk factors was evaluated on Cardiovascular death (26% increase in risk (age 25-45), 10% increase (age 46-77), 95% CI 5-50 (age 25-45), 2-19 (age 46-77)). A 10 mm Hg increase in pulse pressure was independently associated with a 26% increased risk of cardiovascular death in persons aged 25-45 and a 10% increased risk in those aged 46-77.