TY - JOUR
T1 - Outcome-driven thresholds for ambulatory pulse pressure in 9938 participants recruited from 11 populations
AU - Gu, Yu-Mei
AU - Thijs, Lutgarde
AU - Li, Yan
AU - Asayama, Kei
AU - Boggia, José
AU - Hansen, Tine W
AU - Liu, Yan-Ping
AU - Ohkubo, Takayoshi
AU - Björklund-Bodegård, Kristina
AU - Jeppesen, Jørgen
AU - Dolan, Eamon
AU - Torp-Pedersen, Christian
AU - Kuznetsova, Tatiana
AU - Stolarz-Skrzypek, Katarzyna
AU - Tikhonoff, Valérie
AU - Malyutina, Sofia
AU - Casiglia, Edoardo
AU - Nikitin, Yuri
AU - Lind, Lars
AU - Sandoya, Edgardo
AU - Kawecka-Jaszcz, Kalina
AU - Imai, Yutaka
AU - Mena, Luis J
AU - Wang, Jiguang
AU - O'Brien, Eoin
AU - Verhamme, Peter
AU - Filipovsky, Jan
AU - Maestre, Gladys E
AU - Staessen, Jan A
AU - International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators
PY - 2014/2
Y1 - 2014/2
N2 - Evidence-based thresholds for risk stratification based on pulse pressure (PP) are currently unavailable. To derive outcome-driven thresholds for the 24-hour ambulatory PP, we analyzed 9938 participants randomly recruited from 11 populations (47.3% women). After age stratification (<60 versus ≥60 years) and using average risk as reference, we computed multivariable-adjusted hazard ratios (HRs) to assess risk by tenths of the PP distribution or risk associated with stepwise increasing (+1 mm Hg) PP levels. All adjustments included mean arterial pressure. Among 6028 younger participants (68 853 person-years), the risk of cardiovascular (HR, 1.58; P=0.011) or cardiac (HR, 1.52; P=0.056) events increased only in the top PP tenth (mean, 60.6 mm Hg). Using stepwise increasing PP levels, the lower boundary of the 95% confidence interval of the successive thresholds did not cross unity. Among 3910 older participants (39 923 person-years), risk increased (P≤0.028) in the top PP tenth (mean, 76.1 mm Hg). HRs were 1.30 and 1.62 for total and cardiovascular mortality, and 1.52, 1.69, and 1.40 for all cardiovascular, cardiac, and cerebrovascular events. The lower boundary of the 95% confidence interval of the HRs associated with stepwise increasing PP levels crossed unity at 64 mm Hg. While accounting for all covariables, the top tenth of PP contributed less than 0.3% (generalized R(2) statistic) to the overall risk among the elderly. Thus, in randomly recruited people, ambulatory PP does not add to risk stratification below age 60; in the elderly, PP is a weak risk factor with levels below 64 mm Hg probably being innocuous.
AB - Evidence-based thresholds for risk stratification based on pulse pressure (PP) are currently unavailable. To derive outcome-driven thresholds for the 24-hour ambulatory PP, we analyzed 9938 participants randomly recruited from 11 populations (47.3% women). After age stratification (<60 versus ≥60 years) and using average risk as reference, we computed multivariable-adjusted hazard ratios (HRs) to assess risk by tenths of the PP distribution or risk associated with stepwise increasing (+1 mm Hg) PP levels. All adjustments included mean arterial pressure. Among 6028 younger participants (68 853 person-years), the risk of cardiovascular (HR, 1.58; P=0.011) or cardiac (HR, 1.52; P=0.056) events increased only in the top PP tenth (mean, 60.6 mm Hg). Using stepwise increasing PP levels, the lower boundary of the 95% confidence interval of the successive thresholds did not cross unity. Among 3910 older participants (39 923 person-years), risk increased (P≤0.028) in the top PP tenth (mean, 76.1 mm Hg). HRs were 1.30 and 1.62 for total and cardiovascular mortality, and 1.52, 1.69, and 1.40 for all cardiovascular, cardiac, and cerebrovascular events. The lower boundary of the 95% confidence interval of the HRs associated with stepwise increasing PP levels crossed unity at 64 mm Hg. While accounting for all covariables, the top tenth of PP contributed less than 0.3% (generalized R(2) statistic) to the overall risk among the elderly. Thus, in randomly recruited people, ambulatory PP does not add to risk stratification below age 60; in the elderly, PP is a weak risk factor with levels below 64 mm Hg probably being innocuous.
KW - Adult
KW - Aged
KW - Antihypertensive Agents
KW - Blood Pressure Monitoring, Ambulatory
KW - Evidence-Based Medicine
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Hypertension
KW - Incidence
KW - Male
KW - Middle Aged
KW - Proportional Hazards Models
KW - Random Allocation
KW - Risk Factors
KW - Treatment Outcome
U2 - 10.1161/HYPERTENSIONAHA.113.02179
DO - 10.1161/HYPERTENSIONAHA.113.02179
M3 - Journal article
C2 - 24324050
VL - 63
SP - 229
EP - 237
JO - Hypertension
JF - Hypertension
SN - 0194-911X
IS - 2
ER -