Article

Increased pulse pressure is associated with structural target organ
damage, especially in elderly patients, increasing cardiovascular risk. Design In
this analysis, we investigated whether high pulse pressure retains a prognostic
effect also when common markers of target organ damage are taken into account.
Methods We analysed an unselected cohort of treated hypertensive patients from
the Campania Salute Network registry ( n = 7336).
Participants with available
cardiac and carotid ultrasound were required to be free of prevalent
cardiovascular disease, with ejection fraction >/=50%, and no more than stage III
Chronic Kidney Disease. The median follow-up was 41 months and end-point was
occurrence of major cardiovascular events (i.e. fatal and non-fatal stroke or
myocardial infarction and sudden death). Based on current guidelines, pulse
pressure >/=60 mm Hg was classified as high pulse pressure ( n = 2356), at the
time of the initial visit, whereas pulse pressure <60 mm Hg was considered normal
( n = 4980). Results High pulse pressure patients were older, more likely to be
women and diabetic, while receiving more antihypertensive medications than normal
pulse pressure (all p < 0.0001). High pulse pressure exhibited greater prevalence
of left ventricular hypertrophy, and carotid plaque than normal pulse pressure
(all p < 0.0001). In Cox regression, high pulse pressure patients had 57%
increased hazard of major cardiovascular events, compared to normal pulse
pressure (hazard ratio = 1.57; 95% confidence interval: 1.12-2.22, p = 0.01), an
effect that was independent of significant prognostic impact of older age, male
sex, diabetes, left ventricular hypertrophy, carotid plaque and less prescription
of anti-renin-angiotensin system therapy. Conclusions High pulse pressure is a
functional marker of target organ damage, predicting cardiovascular events in
hypertensive patients, even independently of well-known structural markers of
target organ damage.

Langue : ANGLAIS