Abstract-Although various studies reported that pulse pressure, an indirect index of arterial stiffening, was an independent risk factor for mortality, a direct relationship between arterial stiffness and all-cause and cardiovascular mortality remained to be established in patients with essential hypertension. A cohort of 1980 essential hypertensive patients who attended the outpatient hypertension clinic of Broussais Hospital between 1980 and 1996 and who had a measurement of arterial stiffness was studied. At entry, aortic stiffness was assessed from the measurement of carotid-femoral pulse-wave velocity (PWV

The presence of high blood pressure, high heart rate, and high serum creatinine were the major determinants of accelerated progression of aortic stiffness in treated hypertensives. This is the first longitudinal study to evaluate the determinants of arterial aging over an extended period of time.

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).

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.)