title: Pulse Pressure and Risk for Cardiovascular Events in Patients With Atherothrombosis: From the REACH Registry.
abstract: BACKGROUND
  Pulse pressure (PP) provides valuable prognostic information in specific populations, but few studies have assessed its value on cardiovascular outcomes in a broad, worldwide population.
  
  
  OBJECTIVE
  The aim of this study was to determine whether PP is associated with major adverse cardiovascular outcomes, independently of mean arterial pressure.
  
  
  METHODS
  Participants from the international REACH (Reduction of Atherothrombosis for Continued Health) registry, which evaluates subjects with clinical atherothrombotic disease or risk factors for its development, were examined. Those with incomplete 4-year follow-up or PP data (final n = 45,087) were excluded. Univariate and multivariate regression analyses were performed to determine the association between PP and cardiovascular outcomes, including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, all myocardial infarction, all stroke, cardiovascular hospitalization, and a combined outcome. PP was analyzed as a continuous and categorical (i.e., by quartile) variable.
  
  
  RESULTS
  The mean age of the cohort was 68 ± 10 years, 35% were women, and 81% were treated for hypertension. The mean blood pressure was 138 ± 19/79 ± 11 mm Hg, rendering a mean PP of 49 ± 16 mm Hg. On univariate analysis, increasing PP quartile was associated with worse outcomes (p < 0.05 for all comparisons). After adjusting for sex, age, current smoking status, history of hypercholesterolemia, history of diabetes, aspirin use, statin use, blood pressure medication use, and mean arterial pressure, PP quartile was still associated with all outcomes except all stroke and cardiovascular death (p < 0.05 for all comparisons). Analysis of PP as a continuous variable yielded similar results.
  
  
  CONCLUSIONS
  In an international cohort of high-risk subjects, PP, a readily available hemodynamic parameter, is associated with multiple adverse cardiovascular outcomes and provides prognostic utility beyond that of mean arterial pressure.
authors.affiliation: Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Senthil
authors.initials: S
authors.lastname: Selvaraj
authors.affiliation: Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Université Paris-Diderot, Sorbonne Paris Cité, Paris, France; FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U-1148, Paris, France; National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom.
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Université Paris-Diderot, Sorbonne Paris Cité, Paris, France; FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U-1148, Paris, France.
authors.forename: Yedid
authors.initials: Y
authors.lastname: Elbez
authors.affiliation: Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Université Paris-Diderot, Sorbonne Paris Cité, Paris, France; FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U-1148, Paris, France; Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France; Université Paris XIII, Bobigny, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sorbets
authors.affiliation: Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Université Paris-Diderot, Sorbonne Paris Cité, Paris, France; FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U-1148, Paris, France.
authors.forename: Laurent J
authors.initials: LJ
authors.lastname: Feldman
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.affiliation: Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Blacher
authors.affiliation: Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts. Electronic address: dlbhattmd@post.harvard.edu.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: blood pressure; diastolic blood pressure; hypertension; systolic blood pressure; wave reflections