title: Association of pulse pressure with cardiovascular outcome is independent of left ventricular hypertrophy and systolic dysfunction: the Strong Heart Study.
abstract: BACKGROUND
  Whether increased pulse pressure (PP) predicts cardiovascular (CV) events independent of left ventricular hypertrophy (LVH) and systolic dysfunction is unclear.
  
  
  METHODS
  Strong Heart Study adults (2946) without clinically overt coronary heart disease were studied. Echocardiographic LV mass >49.2 g/m(2.7) in men or >46.7 g/m(2.7) in women defined LVH. Clinical, metabolic, and echocardiographic characteristics were evaluated among participants divided in quartiles of PP (cut points: 42, 52, and 64 mm Hg). Mean follow-up for evaluation of all-cause and CV mortality was approximately 7 years.
  
  
  RESULTS
  Mean age, proportion of women, and proportion of participants with diabetes increased across quartiles of PP. Partially by definition, the proportion of participants with hypertension was also higher with wider PP. Systolic and mean blood pressure (BP) increased whereas diastolic BP did not differ significantly across quartiles of PP. The LV mass index was higher whereas ejection fraction (EF) tended to be lower with wider PP. The CV mortality and all-cause mortality were higher in the highest quartile of PP. Wider PP predicted CV mortality independently of traditional risk factors, LVH and reduced EF.
  
  
  CONCLUSIONS
  Wider PP was associated with a higher hazard ratio of CV mortality independent of traditional CV risk factors, LVH and reduced EF in adults without overt coronary heart disease.
authors.affiliation: Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Palmieri
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hollywood
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Bella
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Liu
authors.forename: Elisa T
authors.initials: ET
authors.lastname: Lee
authors.forename: Lyle G
authors.initials: LG
authors.lastname: Best
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Roman
mesh_terms: D000368:Aged; D001794:Blood Pressure; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012307:Risk Factors; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*