doi: 10.1161/hy1001.092966
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Hypertension. 2001;38:793.)
© 2001 American Heart Association, Inc.
Scientific Contributions |
Cardiovascular Risk Assessment Using Pulse Pressure in the First National Health and Nutrition Examination Survey (NHANES I)
From the Clinical Trials Group, National Heart, Lung, and Blood Institute (M.D., J.N., M.W.), Bethesda, Md; and Cardiovascular Engineering Inc (G.M.) and Division of Cardiology, Brigham and Women’s Hospital (M.P.), Boston, Mass.
Correspondence to Michael J. Domanski, MD, National Heart, Lung, and Blood Institute, Rockledge II Center, 6701 Rockledge Dr, Room 8146, Bethesda, MD 20892-7936.
Abstract—— Increased stiffness of the conduit arteries has been associated with increased risk of death and cardiovascular death in a number of populations. None of these populations, however, are fully representative of the US population. The cohort examined in the First National Health and Nutrition Examination Survey (NHANES I) that was free of overt cardiovascular disease was selected to be representative of the US population. We assessed and quantified the increased risk of death associated with elevated pulse pressure in this population. A cohort of 5771 subjects from NHANES I was used to determine the value of adding pulse pressure to standard cardiovascular disease risk factors for assessment of the risk of death during a mean follow-up period of 16.5 years. Analyses were performed by use of the SUDAAN statistical package for performing Cox proportional regression, logistic regression, and other standard methods in complex, weighted samples. Pulse pressure increased with increasing age, body mass index, cholesterol level, and mean arterial pressure. With increasing pulse pressure, the percentage of cigarette smokers decreased and the percentage of diabetics increased. Despite these associations with known risk factors, pulse pressure was independently predictive of an increased risk of death from cardiovascular disease, coronary heart disease, and all-cause mortality. It provides independent prognostic information beyond that provided by known risk factors that were evaluated in this study, including the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure hypertension classification. A 10 mm Hg increase in pulse pressure in persons 25 to 45 of age was associated with a 26% increase in risk of cardiovascular death (95% confidence interval [CI], 5 to 50) and with an 10% increase (95% CI, 2 to 19) in persons 46 to 77 years of age. In a cohort designed to be representative of the US population, elevated pulse pressure has been shown to provide independent prognostic information. This variable may be a marker for the extent of vascular disease and may contribute to the occurrence of clinical events.
Key Words: pulse • arteries • cardiovascular diseases
This article has been cited by other articles:
 |
|
 |
|
  L. M. Silva, E. A.P. Steegers, A. Burdorf, V. W.V. Jaddoe, L. R. Arends, A. Hofman, J. P. Mackenbach, and H. Raat No Midpregnancy Fall in Diastolic Blood Pressure in Women With a Low Educational Level: The Generation R Study Hypertension, October 1, 2008; 52(4): 645 - 651. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Zheng, Z. Sun, J. Li, R. Zhang, X. Zhang, S. Liu, J. Li, C. Xu, D. Hu, and Y. Sun Pulse Pressure and Mean Arterial Pressure in Relation to Ischemic Stroke Among Patients With Uncontrolled Hypertension in Rural Areas of China Stroke, July 1, 2008; 39(7): 1932 - 1937. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Roman, R. B. Devereux, J. R. Kizer, E. T. Lee, J. M. Galloway, T. Ali, J. G. Umans, and B. V. Howard Central Pressure More Strongly Relates to Vascular Disease and Outcome Than Does Brachial Pressure: The Strong Heart Study Hypertension, July 1, 2007; 50(1): 197 - 203. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. G. Moulakakis, D. P. Sokolis, D. N. Perrea, T. Dosios, I. Dontas, M. V. Poulakou, C. A. Dimitriou, G. Sandris, and P. E. Karayannacos The Mechanical Performance and Histomorphological Structure of the Descending Aorta in Hyperthyroidism Angiology, June 1, 2007; 58(3): 343 - 352. [Abstract] [PDF]
|
|
|
|
 |
|
 G. F. Mitchell, C.-Y. Guo, E. J. Benjamin, M. G. Larson, M. J. Keyes, J. A. Vita, R. S. Vasan, and D. Levy Cross-Sectional Correlates of Increased Aortic Stiffness in the Community: The Framingham Heart Study Circulation, May 22, 2007; 115(20): 2628 - 2636. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Chen, P. Factor-Litvak, G. R. Howe, J. H. Graziano, P. Brandt-Rauf, F. Parvez, A. van Geen, and H. Ahsan Arsenic Exposure from Drinking Water, Dietary Intakes of B Vitamins and Folate, and Risk of High Blood Pressure in Bangladesh: A Population-based, Cross-sectional Study Am. J. Epidemiol., March 1, 2007; 165(5): 541 - 552. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J M Gonzalez-Clemente, G Gimenez-Perez, C Richart, M Broch, A Caixas, A Megia, O Gimenez-Palop, I Simon, D Mauricio, and J Vendrell The tumour necrosis factor (TNF)-{alpha} system is activated in accordance with pulse pressure in normotensive subjects with type 1 diabetes mellitus Eur. J. Endocrinol., November 1, 2005; 153(5): 687 - 691. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. V. Nair, L. A. Chaput, E. Vittinghoff, D. M. Herrington, and for the Heart and Estrogen/Progestin Replacement S Pulse Pressure and Cardiovascular Events in Postmenopausal Women With Coronary Heart Disease Chest, May 1, 2005; 127(5): 1498 - 1506. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-G. Wang, J. A. Staessen, S. S. Franklin, R. Fagard, and F. Gueyffier Systolic and Diastolic Blood Pressure Lowering as Determinants of Cardiovascular Outcome Hypertension, May 1, 2005; 45(5): 907 - 913. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hernelahti, H. O. Tikkanen, J. Karjalainen, and U. M. Kujala Muscle Fiber-Type Distribution as a Predictor of Blood Pressure: A 19-Year Follow-Up Study Hypertension, May 1, 2005; 45(5): 1019 - 1023. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Nakano, K. Konishi, K. Furuya, K. Uehara, M. Nishizawa, A. Nakagawa, T. Kigoshi, and K. Uchida A Prognostic Role of Mean 24-h Pulse Pressure Level for Cardiovascular Events in Type 2 Diabetic Subjects Under 60 Years of Age Diabetes Care, January 1, 2005; 28(1): 95 - 100. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Herrington, W. V. Brown, L. Mosca, W. Davis, B. Eggleston, W. G. Hundley, and J. Raines Relationship Between Arterial Stiffness and Subclinical Aortic Atherosclerosis Circulation, July 27, 2004; 110(4): 432 - 437. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, H. Parise, E. J. Benjamin, M. G. Larson, M. J. Keyes, J. A. Vita, R. S. Vasan, and D. Levy Changes in Arterial Stiffness and Wave Reflection With Advancing Age in Healthy Men and Women: The Framingham Heart Study Hypertension, June 1, 2004; 43(6): 1239 - 1245. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Domanski and M. Proschan The metabolic syndrome J. Am. Coll. Cardiol., April 21, 2004; 43(8): 1396 - 1398. [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, Y. Lacourciere, J.-P. Ouellet, J. L. Izzo Jr, J. Neutel, L. J. Kerwin, A. J. Block, and M. A. Pfeffer Determinants of Elevated Pulse Pressure in Middle-Aged and Older Subjects With Uncomplicated Systolic Hypertension: The Role of Proximal Aortic Diameter and the Aortic Pressure-Flow Relationship Circulation, September 30, 2003; 108(13): 1592 - 1598. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, J. L. Izzo Jr, Y. Lacourciere, J.-P. Ouellet, J. Neutel, C. Qian, L. J. Kerwin, A. J. Block, and M. A. Pfeffer Omapatrilat Reduces Pulse Pressure and Proximal Aortic Stiffness in Patients With Systolic Hypertension: Results of the Conduit Hemodynamics of Omapatrilat International Research Study Circulation, June 25, 2002; 105(25): 2955 - 2961. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S.E. Greenwald Pulse pressure and arterial elasticity QJM, February 1, 2002; 95(2): 107 - 112. [Full Text] [PDF]
|
|