Increased Pulse Pressure and Risk of Heart Failure in the Elderly

Chae, Claudia U.; Pfeffer, Marc A.; Glynn, Robert J.; Mitchell, Gary F.; Taylor, James O.; Hennekens, Charles H.

doi:10.1001/jama.281.7.634

Cited by 511 publications

(353 citation statements)

References 40 publications

(67 reference statements)

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“…We found an association between ASI and HF after adjustment for traditional CVD risk factor but it had little discriminating power. We found a strong association between PP and HF, similar to 2 previous studies that found PP independently predicted chronic HF in the Framingham Heart Study population36 and an elderly population 37…”

Section: Discussionsupporting

confidence: 91%

Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

Said

Eppinga

Lipšic

et al. 2018

JAHA

165

131

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BackgroundVascular aging results in stiffer arteries and may have a role in the development of cardiovascular disease (CVD). Arterial stiffness index (ASI), measured by finger photoplethysmography, and pulse pressure (PP) are 2 independent vascular aging indices. We investigated whether ASI or PP predict new‐onset CVD and mortality in a large community‐based population.Methods and ResultsWe studied 169 613 UK Biobank participants (mean age 56.8 years; 45.8% males) who underwent ASI measurement and blood pressure measurement for PP calculation. Mean±SD ASI was 9.30±3.1 m/s and mean±SD PP was 50.98±13.2 mm Hg. During a median disease follow‐up of 2.8 years (interquartile range 1.4–4.0), 18 190 participants developed CVD, of which 1587 myocardial infarction (MI), 4326 coronary heart disease, 1192 heart failure, and 1319 stroke. During a median mortality follow‐up of 6.1 years (interquartile range 5.8–6.3), 3678 participants died, of which 1180 of CVD. Higher ASI was associated with increased risk of overall CVD (unadjusted hazard ratio 1.27; 95% confidence interval [CI], 1.25–1.28), myocardial infarction (1.38; 95% CI, 1.32–1.44), coronary heart disease (1.31; 95% CI, 1.27–1.34), and heart failure (1.31; 95% CI 1.24–1.37). ASI also predicted mortality (all‐cause, CVD, other). Higher PP was associated with overall CVD (1.57; 95% CI, 1.55–1.59), myocardial infarction (1.48; 95% CI, 1.42–1.54), coronary heart disease (1.47; 95% CI, 1.43–1.50), heart failure (1.47; 95% CI, 1.40–1.55), and CVD mortality (1.47; 95% CI, 1.40–1.55). PP improved risk reclassification of CVD in a non–laboratory‐based Framingham Risk Score by 5.4%, ASI by 2.3%.Conclusions ASI and PP are independent predictors of CVD and mortality outcomes. Although both improved risk prediction for new‐onset disease, PP appears to have a larger clinical value than ASI.

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Section: Discussionsupporting

confidence: 91%

Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

Said

Eppinga

Lipšic

et al. 2018

JAHA

165

131

View full text Add to dashboard Cite

show abstract

“…Although not statistically significant in multivariate analysis, TACS was associated with incidence of heart failure admission during follow‐up in univariate analysis—an observation that perhaps warrants further study, given that heart failure has been reported to be associated with arterial stiffening in the elderly 30. Albeit, because our data did not include the measurement of arterial stiffening, further larger studies are clearly required to assess the association, if any, between aortic calcification, arterial stiffening, and incidence of heart failure.…”

Section: Discussionmentioning

confidence: 85%

Association of Thoracic Aorta Calcium Score With Exercise Blood Pressure Response and Clinical Outcomes in Elderly Individuals: Differential Impact of Aorta Calcification Compared With Coronary Artery Calcification

Cho

Chang

Cho

et al. 2016

JAHA

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BackgroundThe structure of the aorta is considered to influence exercise systolic blood pressure (SBP) response, which, in turn, might impact upon adverse outcomes. The current study sought to investigate the relationship of aortic calcification and exercise SBP with adverse outcomes among elderly individuals.Methods and ResultsWe retrospectively reviewed 702 elderly individuals (>65 years of age) without obstructive coronary artery disease (CAD; luminal stenosis <50%) who underwent coronary computed tomography (CT) and exercise treadmill testing. ΔSBP stage2 and ΔSBP peak were defined as the difference in systolic blood pressure (SBP) between rest and stage 2 or peak exercise, respectively. Thoracic aortic calcium score (TACS) and coronary artery calcium score (CACS) were measured using CT scanning procedures. The primary endpoints were defined as all‐cause death, admission for heart failure, obstructive CAD requiring coronary intervention, and stroke. In multivariable models, ΔSBP stage2 and ΔSBP peak were positively related with log(TACS+1), even after adjusting for various clinical variables, baseline SBP, and CACS (P<0.001). During a median follow‐up period of 65 months, there were 59 events (8.4%). In a multivariate Cox regression model, independent predictors for all events were age (hazard ratio [HR], 1.12; 95% CI, 1.05–1.19; P<0.001), dyslipidemia (HR, 1.96; 95% CI, 1.14–3.37; P=0.015), and the 4th quartile of TACS (HR, 1.24; 95% CI, 1.03–1.49; P=0.024). Among individual events, the 4th quartile of TACS was the only independent predictor for stroke (HR, 2.15; 95% CI, 1.09–5.13; P=0.044), whereas CACS ≥400 mm3 was an independent predictor for obstructive CAD requiring intervention (HR, 7.04; 95% CI, 1.58–31.36; P=0.010).ConclusionsAortic calcification was related to SBP response during exercise and was an independent predictor for outcomes, especially stroke, regardless of resting SBP or CACS.

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“…Increased PP is also associated with new onset congestive heart failure in middle-aged 4 and elderly subjects. 5 Finally, increased PP is related to cardiovascular mortality in patients with symptomatic or asymptomatic systolic heart failure. 6,7 In all these populations, PP is considered as a surrogate marker of arterial stiffness.…”

Section: Introductionmentioning

confidence: 99%

Interaction between pulse wave velocity, augmentation index, pulse pressure and left ventricular function in chronic heart failure

Logeart

et al. 2005

J Hum Hypertens

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Pulse wave velocity (PWV), the carotid augmentation index (AIx), and pulse pressure (PP) may be prognostic factors in heart failure, but the possible influence of the ejection fraction (EF) and other simple haemodynamic variables on them has not been investigated in this setting. Noninvasive methods were used to measure carotid-radial (CR), carotid-femoral (CF) PWV and AIx, and brachial PP, in 135 consecutive patients with stable symptomatic chronic heart failure. The patients were divided into two groups, with preserved (X40%) or reduced (o40%) EF. CF-PWV, AIx and PP were lower in the decreased EF group (8.8572.77 versus 10.6072.75 m/s, Po0.001; 121721 versus 132724, P ¼ 0.009 and 41719 versus 67717 mmHg, Po0.001), but CR-PWV values were similar regardless of the EF status. These results were not modified after adjustment for age and sex. Multiple regression analysis showed that AIx and PP were systematically related to time domain parameters (heart rate or ejection duration) and EF, whatever the group. CF-PWV was weakly related to time domain values and unrelated to mean blood pressure (BP) or EF in the preserved EF group, whereas it was related to both mean BP and EF in the low EF group. In conclusion, whatever the EF level, PP and AIx were strongly modulated in the time domain, by pressure and by the EF level. The same relationships were found with CF-PWV, but only in the reduced EF group. Whether CF-PWV is the best prognostic factor in patients with 'diastolic' heart failure must be confirmed in a prospective study.

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Increased Pulse Pressure and Risk of Heart Failure in the Elderly

Abstract: Pulse pressure, an easily measurable correlate of pulsatile hemodynamic load, is an independent predictor of risk of CHF in this elderly cohort.

Cited by 511 publications

References 40 publications

Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

Association of Thoracic Aorta Calcium Score With Exercise Blood Pressure Response and Clinical Outcomes in Elderly Individuals: Differential Impact of Aorta Calcification Compared With Coronary Artery Calcification

Interaction between pulse wave velocity, augmentation index, pulse pressure and left ventricular function in chronic heart failure

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