title: Pulse pressure and adverse outcomes in women: a report from the Women's Ischemia Syndrome Evaluation (WISE).
abstract: BACKGROUND
  Recent data suggest that brachial pulse pressure (PP) may be a better predictor of outcome than systolic or diastolic blood pressure (SBP/DBP). We sought to investigate the relative contributions of these indices to risk for adverse outcomes in women with suspected coronary artery disease (CAD) and myocardial ischemia.
  
  
  METHODS
  Among 857 women referred for angiography for suspected myocardial ischemia, baseline evaluations were performed, and the women were followed for clinical outcome. Relationships between baseline characteristics, blood pressure components, and outcomes were evaluated. Separate multivariate stepwise Cox regression models for PP and SBP (expressed in 10 mm Hg increments) were constructed and included covariates significantly associated with adverse outcomes.
  
  
  RESULTS
  After 5.2 years (mean), univariate testing identified higher PP associated with higher risk for cardiovascular (CV) mortality and adverse CV outcomes than SBP, DBP, or mean arterial pressure (MAP). Multivariate modeling identified both PP and SBP associated with adverse CV outcomes, but only PP was significantly associated with higher CV mortality. When both PP and SBP were included in the model, only PP remained an independent predictor of adverse outcomes for CV events.
  
  
  CONCLUSIONS
  In women with suspected CAD and myocardial ischemia, PP is a stronger predictor of adverse outcomes than SBP, DBP, or MAP with an 18% excess mortality risk for every 10 mm Hg increase in PP. Further investigations into pathophysiologic mechanisms and specific pharmacologic approaches to modifying this novel target are warranted.
authors.affiliation: Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
authors.forename: R David
authors.initials: RD
authors.lastname: Anderson
authors.forename: B Clay
authors.initials: BC
authors.lastname: Sizemore
authors.forename: Genevieve M
authors.initials: GM
authors.lastname: Barrow
authors.forename: B Delia
authors.initials: BD
authors.lastname: Johnson
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Gregory O
authors.initials: GO
authors.lastname: von Mering
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Handberg
authors.forename: Wilmer W
authors.initials: WW
authors.lastname: Nichols
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D016387:Women's Health