Pulse pressure (PP), defined as the difference between the systolic and diastolic blood pressure, has gained considerable clinical significance in the recent years as a potential indicator of cardiovascular risk. Now, a recent study published in the Journal of General Internal Medicine reports the use of PP monitoring as an independent predictor of mortality in aged hospitalized patients.
Avraham Weiss, Senior Physician, Department of Geriatrics at the Rabin Medical Center, Petah Tikvah, Israel, and colleagues, conducted the prospective study on 420 hospitalized men aged more than 60 years (mean age 81.4±7 years) admitted to the acute geriatric ward. The follow-up period was 3.46±1.87 years. A PP of 62.5 mmHg was identified as the cutoff point, and the patients were classified into two groups as having high PP (>62.5 mmHg; N=304) or low PP (≤62.5 mmHg; N=116).
It was observed that the mortality rate was higher in patients with high PP compared to those with low PP. Review of mortality data using death certificates during the follow-up period revealed that 201 patients died: 155 (51%) patients in the high PP group and 46 (39.7%) in the low PP group (p=0.038). An association between pulse pressure and all-cause mortality persisted (HR=1.69; 95% CI=1.19-2.38; P=0.003) even after controlling for age, gender, conditions such as atrial fibrillation, diabetes and heart rate.
Blacher et al (Archives of Internal Medicine, 2000) performed a meta-analysis of three trials and concluded that PP may determine the cardiovascular risk in elderly hypertensives. A 10 mmHg wider pulse pressure increased cardiovascular risk from 13% for coronary end points (P=0.02) to almost 20% for cardiovascular mortality (P= 0.001), after controlling for mean pressure and other covariates.
Verdecchia, in his review (Italian Heart Journal, 2001) discussed the importance of PP as a predictor of cardiovascular risk, especially in persons aged 55 years or more. The review states that increased PP may be an indicator of hardened arteries resulting from atherosclerosis. An average ambulatory PP >53 mmHg signified an increased cardiovascular risk. However, cerebrovascular risk was suggested to be better predicted by the mean blood pressure than the PP. An earlier study carried out by Casiglia et al (Journal of Human Hypertension, 2002) also validated the significance of PP in predicting coronary mortality in elderly women. Additionally, the researchers concluded that the prognostic value of PP is much greater than measuring systolic or diastolic pressure alone.
The current study indicates the potential of PP in providing prognostic information beyond that of known cardiovascular disease, and may assist in future therapeutic decision-making in aged hospitalized patients.
References
1. Weiss A, Boaz M, Beloosesky Y, Kornowski R, Grossman E. Pulse pressure predicts mortality in elderly patients. J Gen Intern Med. 2009 Aug;24(8):893-6.
2. Blacher J, Staessen JA, Girerd X, et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med. 2000 Apr 24;160(8):1085-9.
3. Verdecchia P. Systolic, diastolic and pulse pressure: prognostic implications [in Italian]. Ital Heart J Suppl. 2001 Apr;2(4):369-74.
4. Casiglia E, Tikhonoff V, Mazza A, Piccoli A, Pessina AC. Pulse pressure and coronary mortality in elderly men and women from general population. J Hum Hypertens. 2002 Sep;16(9):611-20.
