Abstract-Aortic pulse wave velocity (PWV) is a significant and independent predictor of cardiovascular mortality in subjects with essential hypertension and in patients with end-stage renal disease. Its contribution to cardiovascular risk in subjects 70 to 100 years old has never been tested. A cohort of 141 subjects (meanϮSD age, 87.1Ϯ6.6 years) was studied in 3 geriatrics departments in a Paris suburb. Together with sphygmomanometric blood pressure measurements, aortic PWV was measured with a validated automatic device. During the 30-month follow-up, 56 patients died (27 from cardiovascular events). Logistic regressions indicated that age (Pϭ0.005) and a loss of autonomy (Pϭ0.01) were the best predictors of overall mortality. For cardiovascular mortality, aortic PWV was the major risk predictor (Pϭ0.016). The odds ratio was 1.19 (95% confidence interval, 1.03 to 1.37). Antihypertensive drug treatment and blood pressure, including systolic and pulse pressure, had no additive role. In subjects 70 to 100 years old, aortic PWV is a strong, independent predictor of cardiovascular death, whereas systolic or pulse pressure was not. This prospective result will need to be confirmed in an intervention trial. Key Words: very old (Ͼ70 years) subjects Ⅲ aortic pulse wave velocity Ⅲ cardiovascular mortality Ⅲ drug treatment of hypertension Ⅲ pulse pressure W ith increasing age, there is a gradual shift from diastolic blood pressure (DBP) to systolic blood pressure (SBP) and then to pulse pressure (PP) as predictors of cardiovascular (CV) risk, mainly from coronary heart disease. In patients Ͻ50 years of age, DBP is the strongest CV predictor. The age range of 50 to 59 years is a transition period when all 3 BP indexes are comparable predictors, and, from 60 years of age, PP becomes superior to both SBP and DBP to predict myocardial infarction. 1-3 In addition, because for a given ventricular ejection aortic stiffness is the major determinant of PP, increased aortic pulse wave velocity (PWV), a classic marker of arterial rigidity, has also been identified as an independent predictor of CV risk in subjects with hypertension, whether in the presence of end-stage renal disease or with preserved renal function. 4 -6 However, these epidemiological findings are limited to cohorts between 50 and 75 years of age.BP increases with age. However, this influence of age differs markedly for SBP and DBP. 7,8 Whereas SBP increases substantially with age, particularly in women after menopause, the increase of DBP with age is less pronounced. Indeed, DBP even tends to fall after 55 years of age. In the elderly, the hemodynamic pattern associating an increase in SBP and a low DBP is a characteristic feature, usually attributed to an age-related increase of arterial stiffness. 7 In elderly populations, SBP and PP are usually considered the major markers of CV risk. 1 However, there is no study in subjects Ͼ70 years old that would indicate whether an increase in PWV could be, in place of SBP and PP, the best independent predictor of CV mortal...

Abstract-There is now increasing evidence that high pulse pressure, which is an indicator of large artery stiffness, is an independent risk factor for cardiovascular mortality, especially coronary mortality, in different populations. We have recently shown in a large French population that in male subjects aged 40 to 69 years, increased pulse pressure was a strong predictor of cardiovascular mortality, especially coronary mortality. In the present report, we analyzed the effect of pulse pressure in men and women of the same cohort after classifying them as normotensive (systolic blood pressure Key Words: cardiovascular diseases Ⅲ coronary artery disease Ⅲ mortality Ⅲ blood pressure Ⅲ normotension Ⅲ hypertension, essential A ging and environmental and genetic factors are responsible for structural and functional changes of the arterial wall media leading to decreased elasticity and increased stiffness.1,2 The alteration of large artery elasticity has deleterious effects on the heart and is responsible for an inadequate increase in systolic pressure and a relative decrease in aortic diastolic pressure at any given value of mean arterial blood pressure (MBP).We have recently shown in a large French population that in male subjects aged 40 to 69 years, increased pulse pressure (PP) was a strong predictor of general and cardiovascular mortality, especially coronary mortality.3 An analysis of the Survival and Ventricular Enlargement (SAVE) study showed that PP measured at the site of the brachial artery was a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function.4 These data, in addition to data from previous studies in hypertensives, 5 suggest that PP itself could be a major predictor of cardiac risk in different populations.Compared with our previous analysis, the purpose of this study was to evaluate whether the role of PP on cardiovascular mortality is significant in normotensive and hypertensive subjects of both genders. We therefore analyzed the effect of PP in men and women after classifying them as normotensive (systolic blood pressure [SBP] Ͻ140 mm Hg and diastolic blood pressure [DBP] Ͻ90 mm Hg) and hypertensive (SBP Ն160 mm Hg or DBP Ն95 mm Hg).

Among adults with IBD, the use of thiopurine monotherapy or anti-TNF monotherapy was associated with a small but statistically significant increased risk of lymphoma compared with exposure to neither medication, and this risk was higher with combination therapy than with each of these treatments used alone. These findings may inform decisions regarding the benefits and risks of treatment.

Abstract-The aim of the present study was to assess the effects of high heart rate on mortality in different subgroups in a French population according to age, gender, and blood pressure levels. We studied 19 386 subjects (12 123 men, 7263 women), aged 40 to 69 years, who had a routine health examination at the Centre d'Investigations Préventives et Cliniques (IPC) between 1974 and 1977. Heart rate (HR) measured by ECG was classified into 4 groups: HR1, Ͻ60; HR2, 60 to 80; HR3, 81 to 100; and HR4, Ͼ100 bpm. Mortality data were recorded for the period of 1974 through 1994. In both sexes, HR was a significant predictor of noncardiovascular mortality. In men, the relative risk (95% confidence interval) for cardiovascular death after adjustment for age and other risk factors in the HR2, HR3, and HR4 groups was 1.35 (1.01 to 1.80), 1.44 (1.04 to 2.00), and 2.18 (1.37 to 3.47), respectively, when compared with HR1. In women, HR did not influence cardiovascular mortality. The association of HR with cardiovascular mortality in men was (1) related to a strong association with coronary but not cerebrovascular mortality, (2) independent of age and hypertension, and (3) influenced by the level of pulse pressure; in patients with high pulse pressure (Ͼ65 mm Hg), accelerated HR was not associated with increased cardiovascular mortality. In conclusion, in a large French population, accelerated resting HR represents an independent predictor of noncardiovascular mortality in both genders, and of cardiovascular mortality in men, independent of age and the presence of hypertension. Further investigations are needed to explain the complex interactions between HR, pulse pressure, and cardiovascular complications. (Hypertension. 1999;33:44-52.)

Increased stiffness of central arteries is statistically associated with reduced creatinine clearance in subjects with mild-to-moderate renal insufficiency, indicating that kidney alterations may interact not only with small but also large arteries, and this is independent of age, blood pressure, and standard risk factors.

Background: Pulse pressure (PP) and aortic pulse wave velocity (PWV) are significant markers of cardiovascular risk, but a similar role for central wave reflections has never been investigated.

In 70-100-year-old subjects, aortic PWV is a strong independent marker of CVD, a finding that remains to be to confirmed by long-term longitudinal studies.

Abstract-To evaluate the risk of cardiovascular disease (CVD) mortality in hypertensive men according to the presence of associated risk factors (ARFs). The population was composed of 29 640 normotensive men without ARFs (reference group) and 60 343 hypertensive men (with and without ARFs) who had a standard health checkup at the Centre d 'Investigations Préventives et Cliniques between 1978 and 1988. Mortality data for a mean period of 14 years were analyzed. The following ARFs were considered: total cholesterol Ն2.5 g/L, personal history of diabetes, smoking (current smokers), body mass index Ͼ28 kg/m 2 , and heart rate Ͼ80 bpm. CVD risk related to the presence of isolated hypertension (assessed in hypertensive subjects without ARFs versus the reference group) increased linearly from 15% at the age of 30 years to 134% at the age of 80 years. In hypertensive subjects, one additional ARF increased CVD risk by 56% (47% to 65%, PϽ0.01) in younger subjects but only by 4% (Ϫ8% to 17%, PϭNS) in older subjects. The role of hypercholesterolemia and tobacco smoking in CVD mortality was significantly higher in hypertensive subjects aged Ͻ55 years than in hypertensive subjects aged Ն55 years (PϽ0.01), whereas the roles of tachycardia and obesity were not affected by age. In younger hypertensive subjects, evaluation of CVD risk and therapeutic strategies should target ARFs. In older subjects, the presence of high blood pressure levels seems to be the major determinant of CVD risk. It has been shown that antihypertensive treatment only partially reverses the risk of cardiovascular complications, especially coronary complications, in hypertensive individuals. 3,4 These results can be explained by the fact that hypertension-related complications, especially coronary heart disease, are determined by a large number of associated risk factors (ARFs), especially metabolic parameters, that are very often altered in both treated and untreated hypertensive individuals. Several studies have reported that hypertensive subjects consistently have higher levels of total cholesterol, body mass index (BMI), heart rate (HR), glycemia, and triglycerides. 5,6 In a previous report, it was observed that hypertension usually occurs in conjunction with other metabolically linked risk factors and that 13% of men and 20% of women present an isolated hypertension. 6 In the Framingham study, it was observed that clusters of Ն3 of these ARFs occurred 4 times as often as expected by chance. 5 Among individuals with hypertension, Ϸ40% of the coronary events in men and Ϸ68% of the coronary events in women are attributable to the presence of Ն2 ARFs. Only 14% of coronary events in hypertensive men and 5% of coronary events in hypertensive women occurred in the absence of additional risk factors. The risk of cardiovascular events among hypertensive patients varies greatly depending on the number of these coexisting risk factors. 7,8 Therefore, increased CVD risk in hypertensive patients may due to the presence of both high BP and ARFs.The latest internatio...