Pulse pressure and risk for myocardial infarction and heart failure in the elderly

作     者：Vaccarino, V Holford, TR Krumholz, HM 

作者机构：Yale Univ Dept Epidemiol & Publ Hlth Sch Med New Haven CT 06520 USA Yale Univ Sch Med Dept Med Cardiol New Haven CT 06520 USA Yale New Haven Hosp Ctr Outcomes Res & Evaluat New Haven CT 06504 USA 

出 版 物：《JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY》 (美国心脏病学会志)

年 卷 期：2000年第36卷第1期

页      面：130-138页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Donaghue Medical Research Foundation, (95-094) National Institute on Aging, NIA, (N01AG002105) National Institute on Aging, NIA 

主　　题：血压 心力衰竭/流行病学 心力衰竭/病因学 心力衰竭/病理生理学 高血压/并发症 高血压/流行病学 高血压/病理生理学 发病率 心肌收缩 心肌梗死/流行病学 心肌梗死/病因学 心肌梗死/病理生理学 预后 脉搏 回顾性研究 危险因素 存活率 老年人 老年人 80以上 女(雌)性 人类 男(雄)性 

摘      要：OBJECTIVES We sought to determine whether pulse pressure (PP), a measure of arterial stiffness, is an independent predictor of the incidence of coronary heart disease (CHD), congestive heart failure (CHF) and overall mortality among community-dwelling elderly. BACKGROUND Current hypertension guidelines classify cardiovascular risk on the basis of elevated systolic blood pressure (SBP) or diastolic blood pressure (DBP) without considering their combined effects. Recent studies suggest that PP is a strong predictor of cardiovascular end points, but few data are available among community elderly. METHODS The study sample included 2,152 individuals age greater than or equal to 65 years, who were participants in the Established Populations for Epidemiologic Study of the Elderly program, free of CHD and CHF at baseline and still alive at one rear after enrollment. Blood pressure was measured at baseline. Incidence of CHD, incidence of CHF and total mortality were monitored in the following 10 years. RESULTS There were 328 incident CHD events, 224 incident CHF events and 1,046 persons who died of any cause. Pulse pressure showed a strong and linear relationship with each end point. After adjusting for demographics, comorbidity and CHD risk factors, a 10-mm Hg increment in PP was associated with a 12% increase in CHD risk (95% confidence interval [CI], 2% to 22%), a 14% increase in CHF risk (95% CI, 5% to 24%), and a 6% increase in overall mortality (95% CI, 0% to 12%). While SEP and mean arterial pressure (MAP) also showed positive associations with the end points, PP yielded the highest likelihood ratio chi-square. When PP was entered in the model in conjunction with other blood pressure parameters (SBP, DBP, MAP or hypertension stage, respectively), the association remained positive for PP but became negative for the other blood pressure variables. The effect of PP persisted after adjusting for current medication use and was present in normotensive individuals and indivi