title: Outcome-driven thresholds for ambulatory pulse pressure in 9938 participants recruited from 11 populations.
abstract: 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.
authors: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Kapucijnenvoer 35, Block D, Box 7001, BE-3000 Leuven, Belgium. jan.staessen@med.kuleuven.be.
authors: Yu-Mei
authors: YM
authors: Gu
authors: Lutgarde
authors: L
authors: Thijs
authors: Yan
authors: Y
authors: Li
authors: Kei
authors: K
authors: Asayama
authors: José
authors: J
authors: Boggia
authors: Tine W
authors: TW
authors: Hansen
authors: Yan-Ping
authors: YP
authors: Liu
authors: Takayoshi
authors: T
authors: Ohkubo
authors: Kristina
authors: K
authors: Björklund-Bodegård
authors: Jørgen
authors: J
authors: Jeppesen
authors: Eamon
authors: E
authors: Dolan
authors: Christian
authors: C
authors: Torp-Pedersen
authors: Tatiana
authors: T
authors: Kuznetsova
authors: Katarzyna
authors: K
authors: Stolarz-Skrzypek
authors: Valérie
authors: V
authors: Tikhonoff
authors: Sofia
authors: S
authors: Malyutina
authors: Edoardo
authors: E
authors: Casiglia
authors: Yuri
authors: Y
authors: Nikitin
authors: Lars
authors: L
authors: Lind
authors: Edgardo
authors: E
authors: Sandoya
authors: Kalina
authors: K
authors: Kawecka-Jaszcz
authors: Yutaka
authors: Y
authors: Imai
authors: Luis J
authors: LJ
authors: Mena
authors: Jiguang
authors: J
authors: Wang
authors: Eoin
authors: E
authors: O'Brien
authors: Peter
authors: P
authors: Verhamme
authors: Jan
authors: J
authors: Filipovsky
authors: Gladys E
authors: GE
authors: Maestre
authors: Jan A
authors: JA
authors: Staessen
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018660:Blood Pressure Monitoring, Ambulatory / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011897:Random Allocation; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: ambulatory blood pressure; epidemiology; population science; pulse pressure