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CLINICAL STUDY

The pulse pressure-to-stroke index ratio predicts cardiovascular events and death in uncomplicated hypertension

^a Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, Faculty of Medicine, University of Leuven K. U. Leuven, Leuven, Belgium

Manuscript received December 4, 2000; revised manuscript received March 19, 2001, accepted April 5, 2001.

Reprint requests and correspondence: Dr. Robert H. Fagard, U. Z. Gasthuisberg-Hypertensie, Herestraat 49, B-3000 Leuven, Belgium
robert.fagard{at}uz.kuleuven.ac.be

OBJECTIVES

The goal of this study was to assess the prognostic power of the pulse pressure-to-stroke index (PP-to-SVi) ratio for cardiovascular events and mortality in patients with uncomplicated hypertension.

BACKGROUND

The prognostic significance of pulse pressure (PP) has been studied repeatedly, but few data are available on the PP-to-SVi ratio.

METHODS

Invasive hemodynamic measurements, including brachial intra-arterial pressure and stroke index by the direct oxygen Fick method, were performed in the period 1972 to 1982 in 192 patients with uncomplicated hypertension; their outcome was ascertained in 1994.

RESULTS

Age at baseline averaged 37 ± 12 years; brachial artery pressure was 165 mm Hg ± 30/89 ± 17 mm Hg; PP averaged 76 mm Hg ± 18 mm Hg, and the PP-to-SVi ratio was 1.67 mm Hg/(ml/m²) ± 0.73 mm Hg/(ml/m²). During 3,057 patient years of follow-up, 19 patients died, and 44 experienced at least one fatal or nonfatal cardiovascular event. Cox regression analysis revealed that the PP-to-SVi ratio was a significant predictor of fatal and nonfatal cardiovascular events and of all-cause mortality after control for age and gender (p < 0.01). Its predictive power persisted after additional adjustment for mean arterial pressure and heart rate. Each 0.75-mm Hg/(ml/m²) increase in the PP-to-SVi ratio was independently associated with a 79% increase in the risk of a cardiovascular event (p = 0.01) and a 2.05-fold greater risk of all-cause mortality (p = 0.01).

CONCLUSIONS

The PP-to-SVi ratio is a significant and independent predictor of cardiovascular events and mortality in selected patients with uncomplicated hypertension.

Abbreviations and Acronyms   BP = blood pressure   CV = cardiovascular   HR = heart rate   PP = pulse pressure   PP-to-SVi ratio = pulse pressure-to-stroke index ratio   RHR = relative hazard rate   SV = stroke volume   SVi = stroke index   SVi-to-PP ratio = stroke index-to-pulse pressure ratio   WHO = World Health Organization

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