Key result
High nighttime ambulatory pulse pressure independently predicted cardiovascular mortality (HR 2.60) and all-cause mortality (HR 1.72) over a 21-year follow-up, although its association with the primary endpoint of cardiovascular events was not significant after adjusting for ambulatory systolic blood pressure (HR 1.33).
Why the study?
Office pulse pressure predicts cardiovascular events and mortality, but ambulatory pulse pressure needed evaluation as a long-term risk factor in middle-aged individuals.
Does high nighttime ambulatory pulse pressure predict cardiovascular and all-cause mortality in middle-aged individuals?
Cohort (n=900)
No
Does high nighttime ambulatory pulse pressure predict cardiovascular and all-cause mortality in middle-aged individuals?
Hazard Ratio: 1.33 (95% CI 0.82–2.14)
High nighttime ambulatory pulse pressure is a significant, independent long-term predictor of cardiovascular and all-cause mortality in middle-aged individuals.
High nighttime ambulatory pulse pressure was associated with mortality but not events after systolic adjustment; hypothesis-generating for risk stratification in middle-aged adults.
Office pulse pressure (PP) is a predictor for cardiovascular (CV) events and mortality. Our aim was to evaluate ambulatory PP as a long-term risk factor in a random cohort of middle-aged participants. The Opera study took place in years 1991-1993, with a 24-h ambulatory blood pressure measurement (ABPM) performed to 900 participants. The end-points were non-fatal and fatal CV events, and deaths of all-causes. Follow-up period, until the first event or until the end of the year 2014, was 21.1 years (mean). Of 900 participants, 22.6% died (29.6% of men/15.6% of women, p<.001). A CV event was experienced by 208 participants (23.1%), 68.3% of them were male (p<.001). High nighttime ambulatory PP predicted independently CV mortality (hazard ratio [HR] 2.60; 95% confidence interval [CI 95%] 1.08-6.31, p=.034) and all-cause mortality in the whole population (HR 1.72; Cl 95% 1.06-2.78, p=.028). In males, both 24-h PP and nighttime PP associated with CV mortality and all-cause mortality (24-h PP HR for CV mortality 2.98; CI 95% 1.11-8.04, p=.031 and all-cause mortality HR 2.40; CI 95% 1.32-4.37, p=.004). Accordingly, nighttime PP; HR for CV mortality 3.13; CI 95% 1.14-8.56, p=.026, and for all-cause mortality HR 2.26; CI 95% 1.29-3.96, p=.004. Cox regression analyses were adjusted by sex, CV risk factors, and appropriate ambulatory mean systolic BP. In our study, high ambulatory nighttime PP was detected as a long-term risk factor for CV and all-cause mortality in middle-aged individuals.
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Lempiäinen et al. (2021) conducted a cohort in General middle-aged population (normotensive and hypertensive) (n=900). High nighttime ambulatory pulse pressure vs. Low nighttime ambulatory pulse pressure was evaluated on Cardiovascular events (major coronary heart disease event or stroke, non-fatal or fatal) (HR 1.33, 95% CI 0.82-2.14). High nighttime ambulatory pulse pressure independently predicted cardiovascular mortality (HR 2.60) and all-cause mortality (HR 1.72) over a 21-year follow-up, although its association with the primary endpoint of cardiovascular events was not significant after adjusting for ambulatory systolic blood pressure (HR 1.33).
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