The importance of pulse pressure on cardiovascular risk and total mortality in the general population: Is sex relevant?

Tadić, Marijana; Quartı-Trevano, Fosca; Bombelli, Michele; Facchetti, Rita; Cuspidi, Cesare; Mancia, Giuseppe

doi:10.1111/jch.13300

Cited by 8 publications

(7 citation statements)

References 35 publications

(46 reference statements)

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“…Recently, Tadic and coworkers 17 found out that 24‐h PP and daytime PP predicted CV events and mortality in a general population of wide age range, but nighttime PP was significant only in men. Earlier, 24‐h, daytime and nighttime PP were recognized as better prognostic factors for CV events in a group of 60 years of age or older, compared with a younger group 28 .…”

Section: Discussionmentioning

confidence: 99%

“… 16 In a population study, daytime and 24‐h PP had a predictive value in the general population, whereas the nighttime PP was a risk factor for men. 17 In a large study consisting of 11 different populations, all individuals within the highest 24‐h PP distribution had an elevated risk for CV events, and those over 60 years had the higher all‐cause mortality than those below. 18 In some studies, however, there has been controversy over significance of ambulatory PP as a predictor for CV and all‐cause mortality.…”

Section: Introductionmentioning

confidence: 99%

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Nighttime ambulatory pulse pressure predicts cardiovascular and all‐cause mortality among middle‐aged participants in the 21‐year follow‐up

Lempiäinen

Ylitalo

Huikuri

et al. 2021

J of Clinical Hypertension

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Office pulse pressure (PP) is a predictor for cardiovascular (CV) events and mortality. Our aim was to evaluate ambulatory PP as a long‐term risk factor in a random cohort of middle‐aged participants. The Opera study took place in years 1991–1993, with a 24‐h ambulatory blood pressure measurement (ABPM) performed to 900 participants. The end‐points were non‐fatal and fatal CV events, and deaths of all‐causes. Follow‐up period, until the first event or until the end of the year 2014, was 21.1 years (mean). Of 900 participants, 22.6% died (29.6% of men/15.6% of women, p<.001). A CV event was experienced by 208 participants (23.1%), 68.3% of them were male (p<.001). High nighttime ambulatory PP predicted independently CV mortality (hazard ratio [HR] 2.60; 95% confidence interval [CI 95%] 1.08–6.31, p=.034) and all‐cause mortality in the whole population (HR 1.72; Cl 95% 1.06–2.78, p=.028). In males, both 24‐h PP and nighttime PP associated with CV mortality and all‐cause mortality (24‐h PP HR for CV mortality 2.98; CI 95% 1.11–8.04, p=.031 and all‐cause mortality HR 2.40; CI 95% 1.32–4.37, p=.004). Accordingly, nighttime PP; HR for CV mortality 3.13; CI 95% 1.14–8.56, p=.026, and for all‐cause mortality HR 2.26; CI 95% 1.29–3.96, p=.004. Cox regression analyses were adjusted by sex, CV risk factors, and appropriate ambulatory mean systolic BP. In our study, high ambulatory nighttime PP was detected as a long‐term risk factor for CV and all‐cause mortality in middle‐aged individuals.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nighttime ambulatory pulse pressure predicts cardiovascular and all‐cause mortality among middle‐aged participants in the 21‐year follow‐up

Lempiäinen

Ylitalo

Huikuri

et al. 2021

J of Clinical Hypertension

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“…In our study, a high TWA PP in the early phase of septic shock showed an independent association with 28-day mortality. High PP is a strong predictor of cardiovascular morbidity/mortality in the geriatric population and among patients with hypertension, coronary heart disease, diabetes mellitus, and renal disease [16][17][18][19][20]. However, there is a paucity of studies about the prognostic value of PP in regards to mortality of patients with sepsis, especially among patients administered a resuscitation therapy bundle including maintaining MAP at > 65 mmHg [21].…”

Section: Discussionmentioning

confidence: 99%

Pulse pressure during the initial resuscitative period in patients with septic shock treated with a protocol-driven resuscitation bundle therapy

Lee

Kim

et al. 2020

Korean J Intern Med

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Background/Aims: Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We investigated associations between time-weighted average (TWA) hemodynamic parameters during the initial resuscitative period and 28-day mortality. Methods: Prospectively collected data were obtained from a septic shock patient registry, according to the Sepsis-3 definition, between 2016 and 2018. The TWA systolic blood pressure, diastolic blood pressure, MAP, shock index, and pulse pressure (PP) during the first 6 hours after shock recognition were compared. Multivariable regression analysis was performed to assess associations between these parameters and 28-day mortality. Results: Of 340 patients with septic shock, 92 died. Only the median TWA PP differed between the survivors and non-survivors (39.2 mmHg vs. 43.0 mmHg, p = 0.020), whereas the other indexes did not. When PP was divided into quartiles (< 34, 34 to 40, 40 to 48, and > 48 mmHg), the mortality rate was higher in the highest quartile (41.2%). Multivariable logistic analysis revealed that PP (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.012 to 1.622; p = 0.039) and PP of > 48 mmHg (OR, 2.25; 95% CI, 1.272 to 3.981; p = 0.005) were independently associated with 28day mortality. Conclusions: PP was significantly associated with 28-day mortality in patients with septic shock and MAP maintained at > 65 mmHg during the first 6 hours. Further studies are warranted to optimize strategies for maintaining PP and MAP at > 65 mmHg during the early resuscitative period.

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“…However, a high proportion of older adults have isolated systolic hypertension, which is significantly associated with mortality . It is important to analyze the role of office and 24-hour pulse pressure in the prediction of mortality …”

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confidence: 99%

Blood Pressure Indexes Associated With Mortality and Cardiovascular Outcomes

Huang

Kuang

Mai

2019

JAMA

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for suicides (Table ). There was no significant trend in deaths of undetermined intent (from 0.51 to 0.79 per 100 000 persons; trend: 0.02 [95% CI, −0.08 to 0.13]) (Figure). During this period, the percentage of opioid-related deaths that was unintentional increased from 73.8% to 90.6%, suicides decreased from 9.0% to 4.0%, and deaths of undetermined intent decreased from 17.2% to 5.4% (all P < .001). Significant increases in opioid-related suicide rates were observed for males, females, all racial/ethnic groups, and all age groups, except between the ages of 35 and 44 years (Table ).Discussion | Between 2000 and 2017, the percentage of opioidrelated deaths that were suicides declined from 9.0% to 4.0%. Despite this proportionate decline, the rate of opioid-related suicides as well as unintentional deaths significantly increased. Recent increases in overdose deaths involving heroin and nonmethadone synthetic opioids, including fentanyl, 3 likely contributed to these trends.Limitations include that proportionately fewer drug overdose deaths did not have information on the specific drug during the study period (decreasing from approximately 25% to 12%), related to increasing toxicological screening, 4 which may have contributed to the increase in opioid-related deaths over time. Also, the validity of coroner or medical examiner determination of manner of death is uncertain 5 and may have changed over time. In some cases, discerning the intent of overdose deaths may be difficult and an unknown proportion classified as undetermined intent may have been suicides. With greater public appreciation of the opioid epidemic since 2010, certifiers may be more likely to consider opioid overdose deaths as unintentional, thereby contributing to the proportionate declines in suicides and undetermined deaths.While the public health crises of opioid overdose deaths and suicide do not appear closely linked, it is nevertheless possible that the national increase in suicides may be partly related to increasing opioid overdose deaths. A better understanding of the contribution of suicidal intent to opioid overdoses could inform suicide prevention efforts, especially considering the high risk of suicide following nonfatal opioid overdose.

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The importance of pulse pressure on cardiovascular risk and total mortality in the general population: Is sex relevant?

Cited by 8 publications

References 35 publications

Nighttime ambulatory pulse pressure predicts cardiovascular and all‐cause mortality among middle‐aged participants in the 21‐year follow‐up

Nighttime ambulatory pulse pressure predicts cardiovascular and all‐cause mortality among middle‐aged participants in the 21‐year follow‐up

Pulse pressure during the initial resuscitative period in patients with septic shock treated with a protocol-driven resuscitation bundle therapy

Blood Pressure Indexes Associated With Mortality and Cardiovascular Outcomes

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