title: Pulse blood pressure and cardiovascular mortality in a population-based cohort of elderly Costa Ricans.
abstract: We studied the relationships between blood pressure (BP), pulse pressure (PP) and cardiovascular (CV) death in older adults using data from 2346 participants enrolled in the Costa Rican CRELES study, mean age 76 years (s.d. 10.2), 31% qualified as wide PP. All covariates included and analyzed were collected prospectively as part of a 4-year home-based follow-up; mortality was tracked for an additional 3 years, identifying 266 CV deaths. Longitudinal data revealed little change over time in systolic BP (SBP), a decline in diastolic BP, and widening of PP. Wide PP was associated with higher risk of CV death but only among individuals receiving antihypertensive drug therapy. Individuals with both wide PP and receiving therapy had 2.6 hazard rate of CV death relative to people with normal-PP plus not taking treatment (TRT), even adjusting for SBP. Increasing PP between visits was significantly associated to higher CV death independently of TRT status. SBP and DBP were not significantly associated to CV death when the effect of PP was controlled for.
  
  
  
  elderly hypertensive patients with wide or increasing PP, especially if receiving TRT, are the highest CV risk group, thus must be carefully assessed, monitored and treated with caution.
authors.affiliation: Centro Centroamericano de Población (CCP), Universidad de Costa Rica, San Pedro, Costa Rica.|School of Public Health, the University of California, Berkeley, CA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Rosero-Bixby
authors.affiliation: Servicio de Geriatría, Hospital Nacional de Geriatría y Gerontología, San José, Costa Rica.
authors.forename: F
authors.initials: F
authors.lastname: Coto-Yglesias
authors.affiliation: School of Public Health, the University of California, Berkeley, CA, USA.
authors.forename: W H
authors.initials: WH
authors.lastname: Dow
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002423:Cause of Death; D003364:Costa Rica / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents