title: Reference frame for home pulse pressure based on cardiovascular risk in 6470 subjects from 5 populations.
abstract: The absence of an outcome-driven reference frame for self-measured pulse pressure (PP) limits its clinical applicability. In an attempt to derive an operational threshold for self-measured PP, we analyzed 6470 participants (mean age 59.3 years; 56.9% women; 22.5% on antihypertensive treatment) from 5 general population cohorts included in the International Database on HOme blood pressure in relation to Cardiovascular Outcome. During 8.3 years of follow-up (median), 294 cardiovascular deaths, 393 strokes and 336 cardiac events occurred. In 3285 younger subjects (<60 years), home PP only predicted all-cause and cardiovascular mortality (P⩽0.036), whereas in 3185 older subjects (⩾60 years) PP predicted total and cardiovascular mortality (P⩽0.0067) and all cardiovascular and coronary events (P⩽0.044). However, PP did not substantially refine risk prediction based on classical risk factors including mean blood pressure (generalized R(2) statistic ⩽0.20%). In older subjects, the adjusted hazard ratios expressing the risk in the upper decile of home PP (⩾76 mm Hg) versus the average risk in whole population were 1.41 (95% confidence interval, 1.09-1.81; P=0.0081) for all-cause mortality, 1.62 (1.11-2.35; P=0.012) for cardiovascular mortality and 1.31 (1.00-1.70; P=0.047) for all fatal and nonfatal cardiovascular end points combined. The low number of events precluded an analysis by tenths of the PP distribution in younger participants. In conclusion, a home PP of ⩾76 mm Hg predicted cardiovascular outcomes in the elderly with the exception of stroke, whereas in younger subjects no threshold could be established.
authors.affiliation: The Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Lucas S
authors.initials: LS
authors.lastname: Aparicio
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
authors.forename: Lutgarde
authors.initials: L
authors.lastname: Thijs
authors.affiliation: 1] Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium [2] Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.affiliation: The Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Jessica
authors.initials: J
authors.lastname: Barochiner
authors.affiliation: Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
authors.forename: José
authors.initials: J
authors.lastname: Boggia
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Gu
authors.affiliation: The Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Paula E
authors.initials: PE
authors.lastname: Cuffaro
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
authors.forename: Yan-Ping
authors.initials: YP
authors.lastname: Liu
authors.affiliation: 1] Population Studies Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland [2] Department of Medicine, Turku University Hospital, Turku, Finland.
authors.forename: Teemu J
authors.initials: TJ
authors.lastname: Niiranen
authors.affiliation: 1] Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan [2] Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.affiliation: Population Studies Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland.
authors.forename: Jouni K
authors.initials: JK
authors.lastname: Johansson
authors.affiliation: Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.affiliation: Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hozawa
authors.affiliation: Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsuji
authors.affiliation: Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.affiliation: Department of Cardiology, Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Sandoya
authors.affiliation: Third Department of Medicine, Hypertension Center, University of Athens, Sotiria Hospital, Athens, Greece.
authors.forename: George S
authors.initials: GS
authors.lastname: Stergiou
authors.affiliation: The Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Gabriel D
authors.initials: GD
authors.lastname: Waisman
authors.affiliation: 1] Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium [2] Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk