NEW YORK (Reuters Health) – A central pulse pressure (PP) of 50 mmHg or higher is predictive of future MI, coronary heart disease, and other cardiovascular events, according to a report in the Journal of the American College of Cardiology for October 27.

Moreover, the results indicate that a high central PP has prognostic value in a variety of patient subgroups, including men (HR, 2.06) and women (HR, 2.03), people over and under 60 years of age (HRs, 1.53 and 2.51, respectively), and individuals with and without diabetes (HRs, 1.84 and 1.91, respectively).

In the initial analysis of the population-based Strong Heart Study (SHS), Dr. Mary J. Roman, from Weill Cornell Medical College, New York, and colleagues had shown that central PP, as a continuous variable, is a better predictor of incident cardiovascular disease than is brachial PP.

In the present analysis, follow-up was extended for an additional year, with the goal of identifying a central PP value that could predict outcomes in clinical settings.

During 5.6 years of follow-up of 2405 subjects who were free of cardiovascular disease at enrollment, 344 patients experienced a cardiovascular event, including MI, coronary heart disease, sudden death, congestive heart failure, or stroke.

Quartiles of central PP (p < 0.001) were better than quartiles of brachial PP (p =0.052) at predicting cardiovascular events, the researchers report.

Multivariate analysis identified the fourth central PP quartile (50 mmHg or higher) as a useful cutoff point for assessing the risk of cardiovascular events. Relative to the first quartile (31 mmHg or lower), only the fourth quartile had a significantly higher event rate (11.0% vs. 21.3%, HR = 1.69, p = 0.003).

“These findings lend strong support for prospective examination of central blood pressure thresholds for prediction of cardiovascular disease events and potential treatment targets in future trials,” the authors conclude.

Reference:
J Am Coll Cardiol 2009;54:1730-1734.