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High pulse pressure identifies heart disease in kidney disease patients

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Pulse pressure can be used to screen patients with chronic kidney disease to identify those with coronary artery calcification who need further evaluation, physicians in Italy suggest.

As reported in the February issue of the Clinical Journal of the American Society of Nephrology posted online on January 28, the researchers determined coronary artery calcification (CAC) with multislice computed tomography in 388 adult patients with stage 2 to 5 chronic kidney disease who were not on dialysis and who were free of symptoms or history of heart disease at baseline.

Lead author Dr. Domenico Russo, at the University Federico II, Naples, and his team found CAC in 42.3% of patients. Of these, the CAC score was > 100 in 64.6%, and > 400 in 26.2%.

The investigators observed a significant positive correlation between pulse pressure — defined as the difference between peak systolic and trough diastolic arterial blood pressure — and CAC.

After adjusting for hypertension and duration of hypertension, a pulse pressure of 60 mm Hg or higher was associated with CAC score > 0 (odds ratio 2.15), CAC score = 100 or higher (OR 2.92), and CAC score = 400 or higher (OR 6.17, p < 0.001 for all three).

After further adjusting for gender, age < 65 years, diabetes, and glomerular filtration rate < 60 mL/min, pulse pressure of 60 mm Hg or higher predicted CAC score of 400 or higher (OR 2.81, p < 0.05).

During follow-up averaging 2 years, there were 22 nonfatal cardiovascular events and 14 fatal events (sudden death or death following acute MI). Thirty-three events — 95% of nonfatal events and 86% of deaths — occurred in patients with CAC.

According to Dr. Russo and associates, “Survival of patients with score of 100 or higher was not different compared with that of patients with score of 400 or higher, underlining that the risk for an outcome is evident even at low score.”

In summary, they write, “High pulse pressure may indicate the presence of vessel wall alterations that lead to adverse outcome.”

Clin J Am Soc Nephrol 2009.