Pulse pressure and adverse outcomes in women: a report from the Women's Ischemia Syndrome Evaluation (WISE).
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.
Anderson
R David
RD
Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
Sizemore
B Clay
BC
Barrow
Genevieve M
GM
Johnson
B Delia
BD
Merz
C Noel Bairey
CN
Sopko
George
G
von Mering
Gregory O
GO
Handberg
Eileen M
EM
Nichols
Wilmer W
WW
Pepine
Carl J
CJ
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