Determinants of Elastic and Stiffening Components of Pulse Pressure Based on 24-Hour Ambulatory Blood Pressure Monitoring

Objective: Pulse pressure (PP), which is a marker of hypertension-mediated organ damage (HMOD) in elderly, can be divided into two components: elastic PP (elPP) and stiffening PP (stPP). Thus, the aim of our study was to explore the determinants of 24-hour elPP and stPP in a national ambulatory blood pressure monitoring (ABPM) database. Design and method: ABPM data of 45517 subjects (age: 56.4 ± 14.9 years, man: 20857 (45.9%)) were collected from the Hungarian ABPM Registry between September 2020 and August 2024. Patients’ history and clinical data were documented in electronic case report forms and were later analyzed together with ABPM data. elPP and stPP were calculated according to published formulas. Results: The elPP was higher in men than woman (46.4 ± 8.2 vs 45.8 ± 9.2 mmHg, p<0.05), whereas stPP was higher in women than man (8.9 ± 5.8 vs 8.3 ± 5.5 mmHg, p<0.05). elPP showed a U-shaped curve with age had a higher value below <40 years (47.3 ± 8 mmHg), than it decreased between 40-49 and 50-59 years (43.7 ± 7.3 and 43.9 ± 8 mmHg, respectively) and it increased again reaching 49.4 ± 9.7 mmHg above the age >70 years, while stPP progressively increased with ageing. Multiple predictors of elPP and stPP were identified based on age categories, sex and heart rate. Conclusions: The evaluation of the determinants of elastic and stiffening PP including several epigenetic factors can help to better understand the pathomechanisms responsible for the development of HMOD and to develop better and individual treatments.