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CARDIOVASCULAR RISK

High Central Pulse Pressure Is Independently Associated With Adverse Cardiovascular Outcome

The Strong Heart Study

Mary J. Roman, MD^_*,_*, Richard B. Devereux, MD^_*, Jorge R. Kizer, MD, MSc^_*, Peter M. Okin, MD^_*, Elisa T. Lee, PhD, Wenyu Wang, PhD, Jason G. Umans, MD, PhD, Darren Calhoun, PhD and Barbara V. Howard, PhD

^_* Division of Cardiology, Weill Cornell Medical College, New York, New York
Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Medstar Research Institute, Washington, DC

Manuscript received March 4, 2009; revised manuscript received May 14, 2009, accepted May 25, 2009.

^_* Reprint requests and correspondence: Dr. Mary J. Roman, Division of Cardiology, Weill Cornell Medical College, 525 East 68th Street, New York, New York 10021 (Email: mroman{at}med.cornell.edu).

Objectives: This study was designed to facilitate clinical use of central pulse pressure (PP). We sought to determine a value that might predict adverse outcome and thereby provide a target for assessment of intervention strategies.

Background: We previously documented that central PP more strongly relates to carotid hypertrophy and extent of atherosclerosis and, more importantly, better predicts incident cardiovascular disease (CVD) than brachial PP.

Methods: Radial applanation tonometry was performed in the third Strong Heart Study examination to determine central blood pressure. Cox regression analyses were performed using pre-specified covariates and quartiles of central and brachial PP.

Results: Among 2,405 participants without prevalent CVD, 344 suffered CVD events during 5.6 ± 1.7 years. Quartiles of central PP (p < 0.001) predicted outcome more strongly than quartiles of brachial PP (p = 0.052). With adjustment for covariates, only the event rate in the fourth quartile of central PP (50 mm Hg) was significantly higher than that in the first quartile (hazard ratio [HR]: 1.69, 95% confidence interval [CI]: 1.20 to 2.39, p = 0.003). Central PP 50 mm Hg was related to outcome in both men (HR: 2.06, 95% CI: 1.39 to 3.04, p < 0.001) and women (HR: 2.03, 95% CI: 1.55 to 2.65, p < 0.001); in participants with (HR: 1.84, 95% CI: 1.41 to 2.39, p < 0.001) and without diabetes (HR: 1.91, 95% CI: 1.29 to 2.83, p = 0.001); and in individuals younger (HR: 2.51, 95% CI: 1.59 to 3.95, p < 0.001) and older (HR: 1.53, 95% CI: 1.19 to 1.97, p = 0.001) than the age of 60 years.

Conclusions: Central PP 50 mm Hg predicts adverse CVD outcome and may serve as a target in intervention strategies if confirmed in other populations and in prospective studies.

Key Words: blood pressure determination • elasticity • hypertension • detection and control • vasculature

Abbreviations and Acronyms   BP = blood pressure   CVD = cardiovascular disease   PP = pulse pressure

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