If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  DG DISPATCH - ASH MEETING: New Risk Factor In Cardiovascular Disease -- Pulse Pressure By Margaret Pearson Special to DG News NEW YORK, NY -- May 25, 1999 -- Current guidelines for the management of hypertension concern themselves primarily with the observation of systolic and diastolic pressure and mean arterial pressure. At the American Society of Hypertension scientific sessions, three separate research papers were presented that highlighted the importance of pulse pressure monitoring in the management of patients with hypertensive disease and these studies also highlighted the importance of pulse pressure as an independent risk factor for future cardiovascular events. Dr. F. Thomas from the Center for Preventive and Clinical Investigations (IPC) in Paris, France presented a cumulative analysis of data acquired on 125,513 men. These men had routine medical examinations performed at the IPC centre in Paris, France during the 10-year period from 1978 to 1988. The blood pressure and heart rate data was taken at rest during a routine medical examination. The cohort of men was divided into three groups: young men (less than 50 years of age); middle aged men (51 to 65 years of age); and older men (greater than 65 years of age). Pulse pressure was also divided into three categories: less than 50 mm Hg; 51 to 65 mm Hg; and greater than 65 mm Hg. Heart rate was divided into four groups: less than 60 beats per minute(BPM); 60-80 BPM; 80-100 BPM; and greater than 100 BPM. In each age group of patients, a reference group was comprised of those patients with lowest pulse pressure: (less than 50 mm HG with a heart rate of less than 60 beats per minute). Dr. Thomas presented the relative risks for cardiovascular mortality for the separate sub-groups of patients. The results demonstrated that pulse pressure and heart rate had an additive/cumulative effect on cardiovascular disease, events and mortality. He noted that this effect was observed in all age groups but that the relative risk was higher in the younger subjects when compared with patients in the older subsets. He also noted that a combination of elevated pulse pressure and elevated heart rate at rest portended a greatly increased risk of future cardiovascular events. Pulse Pressure, Not Mean Pressure, Determines Cardiovascular Risk In Older Hypertensive Patients In this study, Dr. J. Gasowski of the Hypertension Unit at the University of Leuven in Belgium also presented data that suggested that pulse pressure, not mean arterial pressure, was a primary determinant of cardiovascular risk in older hypertensive patients. In his presentation, Dr. Gasowski reviewed data from the European Working Party on High Blood Pressure in the elderly (840 patients), the Systolic Hypertension in Europe Trial (4,695 patients) and the Systolic Hypertension in China Trial (2,394 patients). Dr. Gasowski said an increase in the pulse pressure by 10 mm Hg, increased the risk of major cardiovascular complications (after controlling for systolic pressure, diastolic pressure, mean arterial pressure and other co-variants) to almost 13 percent for all coronary end-points and to nearly 20 percent for all cardiovascular mortality. In his summary, Dr. Gasowski explained that, especially in older hypertensive patients, pulse pressure (not mean arterial pressure) is the major determinant of cardiovascular risk. He said he felt the review of these findings from the three clinical trials deserved further evaluation in randomised, controlled clinical trials. Pulse Pressure: A Predictor Of Cardiovascular Mortality Among Young Normotensive Subjects Dr. J. Fang of the Albert Einstein College of Medicine in New York City, spoke about how pulse pressure was evaluated as a predictor of cardiovascular mortality among young, normotensive subjects. Dr. Fang utilised data acquired from the first National Health and Nutrition Examination Survey, and Epidemiologic Follow-up Study to assess the association of pulse pressure to all cause and cardiovascular mortality in a representative normal blood pressure population. The baseline data was acquired from 1971 to 1975 and mortality data was acquired through 1992. The study included 7,346 patients with normal baseline blood pressures (less than 140/90 mm Hg) . Patients had no history of hypertension and had a mean age of 43.4 years. The patients demonstrated a mean blood pressure of 118/76 mm Hg with an average pulse pressure of 42 mm Hg and a mean arterial pressure of 90 mm Hg. The average follow-up of the study was 17.4 years. During that time there were 1,143 deaths - 577 of which were felt to be due to cardiovascular disease. The data was controlled for age and known cardiovascular disease risk factors. Increased adjusted cardiovascular mortality related to elevated pulse pressure was demonstrated only in the younger subjects (male and female). Dr. Fang said that in the younger patients with pulse pressures greater than 50 mm Hg, cardiovascular mortality was increased (70 percent in men and 310 percent in women) when compared with patients to pulse pressures of less than 36 mm Hg. These findings were not present in older patients. In conclusion, Dr. Fang explained that elevated pulse pressure (which has previously been reported as an indicator of cardiovascular risk in hypertensive patients) also seems to be an indicator for increased cardiovascular mortality in younger, normotensive patients (less than 65 years of age).
|
