Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor

Abstract

Background Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan. Methods In 4663 young (18-49 years) and 7185 older adults (≥50 years), brachial PP was recorded over 24-hour. Total mortality and all major cardiovascular events combined (MACE) were co-primary endpoints. Cardiovascular death, coronary events and stroke were secondary endpoints. Results In young adults (median follow-up, 14.1 years; mean PP, 45.1 mmHg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1000 person-years. The adjusted hazard ratios expressed per 10mmHg PP increments were less than unity (P≤0.027) for MACE (0.67; 95% CI, 0.47-0.96) and cardiovascular death (0.33; 95% CI, 0.11-0.75). In older adults (median follow-up, 13.1 years; mean PP, 52.7 mmHg), the endpoint rates, expressing absolute risk, ranged from 22.5 to 45.4 per 1000 person-years and the adjusted hazard ratios, reflecting relative risk, from 1.09 to 1.54 (P<0.0001). The PPrelated relative risks of death, MACE and stroke decreased >3-fold from age 55 to 75 years, whereas absolute risk rose by a factor 3. Conclusions From 50 years onwards, the PP-related relative risk decreases, whereas absolute risk increases. From a lifecourse perspective, young adulthood provides a window of opportunity to manage risk factors and prevent target organ damage as forerunner of premature death and MACE. In older adults, treatment should address absolute risk, thereby extending life in years and quality.

Ambulatory pulse pressure and its contributors in autosomal dominant polycystic kidney disease

“…In a recently published study analyzing the results from the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome (IDACO) that comprises over 11,000 participants, the mean PP was higher (49.7 ±10.0 mm Hg). 19 Also, median PP in adults >50 years of age from our study (50 mm Hg) fits into the low-middle PP category (41.17-51.19 mm Hg) from IDACO. 19 This may come as a surprise, given the aforementioned facts imposing a substantial risk of AS and vascular resistance on ADPKD patients.…”

“…19 Also, median PP in adults >50 years of age from our study (50 mm Hg) fits into the low-middle PP category (41.17-51.19 mm Hg) from IDACO. 19 This may come as a surprise, given the aforementioned facts imposing a substantial risk of AS and vascular resistance on ADPKD patients. On the other hand, this finding goes in line with the excellent prognosis and low mortality rate in RRT patients with ADPKD, as compared to other etiologies.…”

Fructose plus High-Salt Diet in Early Life Results in Salt-Sensitive Cardiovascular Changes in Mature Male Sprague Dawley Rats

“…Slight increases in diastolic blood pressure occurred which prevented any statistically significant increases in pulse pressure which were, nonetheless, nearly two-fold higher than in the GCS-GCS group. Importantly, systolic blood pressure and pulse pressure are strongly correlated with subsequent major adverse cardiac events [ 36 , 37 ]. Thus, fructose alone or combined with high salt during the critical adolescent period predisposes to salt sensitivity and hypertension in maturity.…”

Predictive power of 24-h ambulatory pulse pressure and its components for mortality and cardiovascular outcomes in 11 848 participants recruited from 13 populations

“…However, in randomly recruited populations, ambulatory PP did not add to risk stratification below age 60, whereas in the elderly, PP was a weak risk factor, with levels below 64 mmHg probably being innocuous [2]. Very recently, we have shown that the relative risks of death, a cardiovascular endpoint, and stroke, associated with ambulatory PP, decreased from 50 to 75 years of age by a factor of 3 to 5, whereas both absolute risk and PP increased [11].…”