Pulsatile versus steady component of blood pressure: a cross-sectional analysis and a prospective analysis on cardiovascular mortality.

Abstract

Studies on the prognostic significance of blood pressure on cardiovascular disease have essentially investigated the levels of diastolic or systolic blood pressure. However, blood pressure may also be divided into two other components: steady (mean arterial pressure) and pulsatile (pulse arterial pressure). The relations of these two components with cardiovascular risk factors and cardiovascular mortality were investigated in 18,336 men and 9,351 women aged 40-69 years, who were followed up for a mean period of 9.5 years. However, the interpretation of the relations is complicated by the strong correlation existing between these two components. A principal component analysis was performed to obtain two independent parameters: a steady and a pulsatile component index, strongly correlated with mean and pulse arterial pressure, respectively. In the cross-sectional analysis, relations were stronger with the steady component index than with the pulsatile component index; an association was found between left ventricular hypertrophy and the pulsatile component index in both sexes. The survival analysis was not performed in women under 55 as only 11 cardiovascular deaths occurred in this group. The steady component index was a strong prognostic factor of all types of cardiovascular death in both sexes. In women, the pulsatile component index was positively correlated to death from coronary artery disease and inversely correlated to stroke. In conclusion, the steady component of blood pressure is a strong risk factor for cardiovascular death in both sexes; the pulsatile component could be a risk factor independent of the steady component in women older than 55 years. (Hypertension 1989; 13:392-400)

Influence of aging on arterial compliance

“…15 This leads to an increase in pulse pressure, which has been shown to be an important cardiovascular risk factor. [17][18][19] This pulse pressure amplification with aging is due to large artery stiffening. Different factors may contribute to this stiffening; for example, a decreased connective tissue elasticity, atherosclerosis and a decrease in smooth muscle relaxation.…”

Pulse pressure and coronary mortality in elderly men and women from general population

“…Pulse pressure (PP), defined as the difference between SBP and diastolic BP (DBP), is usually employed to explore this component. In many studies, [3][4][5][6][7][8][9] subjects with higher PP were found to have a higher risk than subjects with lower PP values at the same age. Some of these studies, nevertheless, took into consideration hypertensive patients 10,11 or groups of subjects 12 rather than people from the general population, and the role of gender was often neglected.…”

Treatment of elderly patients with isolated systolic hypertension with isosorbide dinitrate in an asymmetric dosing schedule

“…[10][11][12] It has been shown that an increase in pulse pressure contributes considerably to the increase in cardiovascular morbidity and mortality seen at higher ages. 13 Pulse pressure, for a given stroke volume, is determined by the ejection rate of the left ventricle, the timing of reflected waves and the visco-elastic properties of the arterial wall, such as large artery compliance. [12][13][14] In elderly patients with ISH (Ͼ50 years of age) the increase in pulse pressure is mainly due to a direct decrease in large artery compliance and to an indirect lowering of arterial compliance by an increase in early pulse wave reflections.…”