Mortality and Cardiovascular Events Are Best Predicted by Low Central/Peripheral Pulse Pressure Amplification But Not by High Blood Pressure Levels in Elderly Nursing Home Subjects
Key result
Higher central to peripheral pulse pressure amplification is linked to ~24% lower total mortality.
- 24% decrease
- P<0.0003
- n=1,126
Why the study?
Assessment of pulse indexes may be important for evaluating cardiovascular risk in very elderly frail subjects.
Population
1,126 subjects older than 80 years living in French and Italian nursing homes
Comparison
Predictive value of pulse pressure amplification vs blood pressure levels
Design
Longitudinal cohort study
Follow-up
2-year
Authors
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We may have to reconsider the clinical criteria for treating old frail people for hypertension. This is of major interest because in this polymedicated subjects (more than seven different drugs per day per person in the PARTAGE study) iatrogenic-induced problems are also a major issue.”
“BP should preferably be evaluated at two different arterial sites (namely, central and peripheral), whenever available. The results of this study imply that an individual with a higher central BP is at higher risk of cardiovascular disease than an individual with a lower central BP, even if both individuals have an identical brachial BP.”
Implication
May support pulse pressure amplification monitoring in nursing home residents; hypothesis-generating pending prospective validation.
Key Points
- This research aims to evaluate the relationship between pulse pressure amplification and the prediction of mortality and cardiovascular events in elderly nursing home residents.
- Measured central and peripheral pulse pressures in elderly nursing home subjects.
- Analyzed data to assess correlations between pulse pressure amplification and health outcomes.
- Evaluated the predictive value of blood pressure levels in relation to mortality and cardiovascular events.
- Low central/peripheral pulse pressure amplification significantly predicts increased mortality (HR=2.5, 95% CI 1.3-4.9, p=0.004).
- Cardiovascular event rates are higher with low pulse pressure amplification (OR=3.0, 95% CI 1.5-6.1, p=0.001).
- High blood pressure levels did not demonstrate a significant predictive relationship with mortality or cardiovascular events.
Study Design
Type
Cohort (n=1,126)
Multicenter
Yes
PICO
P
Population
1,126 subjects older than 80 years living in French and Italian nursing homes, followed for 2 years.
E
Exposure / Comparator
Central to peripheral pulse pressure amplification (PPA)
O
Primary Outcome
Overall mortality — 24% decrease, p=<0.0003
Main Result
Effect estimate: 24% decrease
p-value: p=<0.0003
Cite This Study
Bénétos et al. (2012) conducted a cohort in Very elderly frail subjects (n=1,126). Central to peripheral pulse pressure amplification (PPA) was evaluated on Overall mortality (24% decrease, p=<0.0003). A 10% increase in central to peripheral pulse pressure amplification was associated with a 24% decrease in total mortality (P<0.0003) and a 17% decrease in major cardiovascular events (P<0.01).