Effect of Aging on the Prognostic Significance of Ambulatory Systolic, Diastolic, and Pulse Pressure in Essential Hypertension

Abstract

Background-This study compared the relative prognostic significance of 24 hour intra-arterial ambulatory systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) parameters in middle-aged versus elderly hypertensives. Methods and Results-A total of 546 subjects aged Ͻ60 years and 142 subjects aged Ն60 years who had undergone baseline pretreatment 24-hour intra-arterial ambulatory blood pressure monitoring were followed for 9.2Ϯ4.1 years. Multivariate analysis showed that in younger subjects, 24-hour, daytime, and nighttime DBP, MAP, and SBP, when considered individually, were positively related to morbid events; DBP parameters provided the best predictive values.In the group Ն60 years (elderly group), 24-hour, daytime, and nighttime PP and SBP were the most predictive parameters, whereas ambulatory DBP and MAP measurements failed to provide any prognostic value. When 24-hour values of SBP and DBP were jointly included in the baseline model, DBP (zϭ2.02, Pϭ0.04) but not SBP (zϭϪ0.43, Pϭ0.67) was related to outcome in younger subjects, whereas in the elderly group, SBP (zϭ3.33, Pϭ0.001) was positively and DBP (zϭϪ1.75, Pϭ0.07) was negatively related to outcome. Clinic blood pressure measurements failed to provide any independent prognostic value in either age group. Conclusions-The relative prognostic significance of ambulatory blood pressure components depends on age; DBP parameters provided the best prognostic value in middle-aged individuals, whereas PP parameters were the most predictive in the elderly. This may reflect differing underlying hemodynamic mechanisms of hypertension in these age groups.

Relationship between blood pressure parameters and pulse wave velocity in normotensive and hypertensive subjects: invasive study

“…In combination with the previous studies, 18,[32][33][34] the present study also suggests that the role of BP parameters as a predictor of PWV could be different according to the age range of the population studied. Further large population-based studies are needed to characterize the age-related changes in the impact of BP on large artery stiffness.…”

“…K In normotensive and untreated hypertensive middle-aged and elderly subjects, pulse pressure showed the strongest correlation with aortic PWV over other BP parameters. K In combination with the previous studies, 18,[32][33][34] our findings also suggest that the role of BP parameters as a predictor of PWV could be different according to the age range of the population studied.…”

“…Because our results also showed prognostic significance of SBP and MAP for aortic PWV and no correlation of DBP with PWV, the findings were in agreement with the previous data. [32][33][34] Interestingly, Nurnberger et al 18 reported a contrary result. They showed DBP was the only important determinant of PWV among all BP parameters.…”

“…The changes were mainly attributed to the age-related large artery stiffness. The effect of ageing on the prognostic significance of BP was reported in hypertensive subjects 33 and Framingham population. 34 By ambulatory intraarterial BP monitoring, DBP parameters provided the best prognostic value for cardiovascular outcomes in the middle aged (o60 years), whereas PP parameters were the most predictive in the elderly (X60 years) individuals.…”

“…34 By ambulatory intraarterial BP monitoring, DBP parameters provided the best prognostic value for cardiovascular outcomes in the middle aged (o60 years), whereas PP parameters were the most predictive in the elderly (X60 years) individuals. 33 With increasing age, the relative prognostic value of BP for coronary heart disease was gradually shifted from DBP to SBP and then to PP in the Framingham heart study. 34 In subjects aged o50 years, DBP was the strongest predictor.…”