High Central Pulse Pressure Is Independently Associated With Adverse Cardiovascular Outcome
Key result
Central pulse pressure ≥50 mmHg is linked to ~69% higher risk of cardiovascular events.
- HR 1.69
- 95% CI 1.20-2.39
- P=0.003
- n=2,405
Why the study?
To facilitate clinical use of central PP, the authors sought to determine a value that might predict adverse outcome and provide a target for intervention strategies.
Does central pulse pressure ≥50 mmHg predict fatal and non-fatal CVD events in adults without prevalent cardiovascular disease?
Population
2,405 participants without prevalent CVD in the 3rd Strong Heart Study exam
Comparison
Quartiles of central PP and brachial PP
Design
Cohort study
Follow-up
5.6±1.7 years
Authors
Discussion
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Implication
Central PP ≥50 mmHg was associated with higher CVD risk; supports further validation as a predictor but should not yet change practice.
Key Points
- To identify a threshold value of central pulse pressure that predicts adverse cardiovascular events and could serve as a target for therapeutic interventions.
- Assessed 2,405 participants without prevalent cardiovascular disease in the Strong Heart Study using radial applanation tonometry to measure central blood pressure during a mean follow-up of 5.6±1.7 years.
- Evaluated incident cardiovascular events across quartiles of central and brachial pulse pressure using multivariable Cox regression models adjusted for traditional risk factors.
- During follow-up, 344 participants experienced cardiovascular events, with event rates rising across central pulse pressure quartiles from 11.0% in quartile 1 to 9.9%, 15.0%, and 21.3% in quartile 4 (p<0.001 for trend).
- Quartiles of central pulse pressure (p<0.001) predicted outcomes more strongly than brachial pulse pressure quartiles (p=0.052), with the fourth quartile (≥50 mmHg) conferring significantly higher risk than the first quartile (HR 1.69, 95% CI: 1.20–2.39, p=0.003).
- A central pulse pressure ≥50 mmHg independently predicted events in men (HR 2.06, 95% CI: 1.39–3.04, p<0.001), women (HR 2.03, 95% CI: 1.55–2.65, p<0.001), individuals with diabetes (HR 1.84, 95% CI: 1.41–2.39, p<0.001), and those without diabetes (HR 1.91, 95% CI: 1.29–2.83, p=0.001).
Study Design
Type
Cohort (n=2,405)
Multicenter
Yes
Structured PICO
Does central pulse pressure ≥50 mmHg predict fatal and non-fatal CVD events in adults without prevalent cardiovascular disease?
P
Population
2,405 American Indian adults without prevalent cardiovascular disease, mean age 63, 65% female, followed for a mean of 5.6 years.
E
Exposure
Central pulse pressure ≥50 mmHg (highest quartile)
C
Comparator
Central pulse pressure <50 mmHg (lowest quartile)
O
Outcome
Fatal and non-fatal CVD events (myocardial infarction, coronary heart disease, sudden death, congestive heart failure, and stroke) at mean 5.6 years follow-uphard clinical
Main Result
Hazard Ratio: 1.69 (95% CI 1.2–2.39)
Absolute Event Rate: 21.3% vs 11%
p-value: p=0.003
Central pulse pressure ≥50 mmHg is a strong, independent predictor of adverse cardiovascular outcomes, outperforming brachial pulse pressure.
Limitations
- Study population limited to American Indians
- Threshold derived from distribution within study population rather than formal threshold estimation
Cite This Study
Roman et al. (2009) conducted a cohort in Without prevalent cardiovascular disease (n=2,405). Central pulse pressure ≥50 mmHg vs. Central pulse pressure <50 mmHg (1st quartile) was evaluated on Fatal and non-fatal CVD events (myocardial infarction, coronary heart disease, sudden death, congestive heart failure, and stroke) (HR 1.69, 95% CI 1.20-2.39, p=0.003). Central pulse pressure ≥50 mmHg increased the risk of fatal and non-fatal cardiovascular events by 69% compared to the lowest quartile (HR 1.69).