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(Hypertension. 1999;33:800-805.)
© 1999 American Heart Association, Inc.
Scientific Contributions |
Stroke Volume/Pulse Pressure Ratio and Cardiovascular Risk in Arterial Hypertension
From the Division of Cardiology, The New York Presbyterian Hospital–Weill Medical College of Cornell University, New York, NY (G.d.S., M.J.R., M.J.K., G.A.M., R.B.D.); the Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy (G.d.S.); and Institute of Clinical Medicine, University of Sassari (Italy) (A.G.).
Correspondence to Dr Giovanni de Simone, Division of Cardiology, The New York Presbyterian Hospital–Weill Medical College of Cornell University, 525 E 68th St, New York, NY 10021. E-mail simogi{at}unina.it
Abstract—Ratio of stroke volume (SV, M-mode echocardiography) to pulse pressure (PP) has been proposed as an estimate of total arterial compliance and has been shown to be related to body size, age, and heart rate in normal adults. SV/PP was estimated in 294 hypertensive patients (98 women) as a raw value by use of SV/body surface area (SVi) and by the ratio of SV/PP to the value predicted by a previously developed equation (%SV/PP). At baseline, the 50 patients who had cardiovascular events over the following 10 years exhibited higher PP and lower SV/PP, SVi/PP, and %SV/PP (all P<0.008) than patients without events. Crude risk of follow-up total and fatal cardiovascular events increased with increasing level of PP and decreasing SV/PP, SVi/PP, and %SV/PP (all P<0.002). In multivariate logistic regression models with continuous covariates, the risk of total cardiovascular events was independently related to increasing age (P<0.0001) and left ventricular (LV) mass index (P<0.003) and decreasing values of %SV/PP (P<0.006) but not to increasing systolic, pulse, or mean blood pressure or gender. Similar although less strong results were obtained with the use of SVi/PP (P<0.02), whereas SV/PP did not enter the model as an independent predictor. Risk of cardiovascular death was only predicted by age and LV mass index. The %SV/PP was also an independent predictor of total cardiovascular events in Cox proportional hazards analysis (exp[b]: 2.49, P<0.001) independent of age (exp[b]: 1.05, P<0.003) and LV mass index (exp[b]: 1.02, P<0.0003), whereas no effect was detected for height. Thus, in patients with arterial hypertension, a reduced ratio of M-mode echocardiographic SV/PP as a percentage of the value predicted by demographic variables is a predictor of cardiovascular morbid events independent of age and LV mass index.
Key Words: hypertension, arterial • echocardiography • cardiac hypertrophy • prognosis • pulse
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