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(Hypertension. 2005;45:53.)
© 2005 American Heart Association, Inc.

Scientific Contributions

Pulse Pressure and Coronary Atherosclerosis Progression in Postmenopausal Women

Girish V. Nair; David Waters; William Rogers; Glen J. Kowalchuk; Thomas D. Stuckey; David M. Herrington

From the Departments of Internal Medicine/Cardiology (G.V.N., D.M.H.) and Public Health Sciences (D.M.R.), Wake Forest University School of Medicine, Winston-Salem, NC; Division of Cardiology (D.W.), San Francisco General Hospital, California; Department of Cardiology (G.J.K.), Carolinas Medical Center, Charlotte, NC; and LeBauer Cardiovascular Associates (T.D.S.), Greensboro, NC.

Correspondence to Dr David M. Herrington, Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail dherring{at}wfubmc.edu

Pulse pressure, an index of large artery stiffness, has been associated with coronary events. However, mechanisms for this association remain unclear. In this study, we examined the relationship between pulse pressure and the progression of coronary atherosclerosis and the effects of hormone replacement therapy (HRT) on pulse pressure in postmenopausal women with angiographically confirmed coronary disease followed for 3.2 years in the Estrogen Replacement in Atherosclerosis (ERA) trial. In the ERA trial, 309 postmenopausal women (mean age 66±7 years) with coronary disease were randomized to estrogen, estrogen plus progestin, or placebo, and followed for 3.2 years. Ten standardized epicardial segments were measured for minimal diameter values at baseline and follow-up using quantitative coronary angiography. For this study, mixed-model analysis of covariance was used to: (1) test the association between pulse pressure and change in mean minimum diameter (MMD) adjusted for baseline MMD and (2) the effect of HRT on follow-up pulse pressure. After adjustment for potential confounders, there was a significant graded increase in progression of coronary stenosis with increasing quartiles of baseline pulse pressure (P test for trend=0.0001). The progression rate in women with the highest quartile of baseline pulse pressure was 5-fold higher than in women in the lowest quartile (P<0.01). In postmenopausal women with coronary disease, increased levels of baseline pulse pressure are associated with subsequent progression of coronary atherosclerosis in postmenopausal women. HRT had no detectable effect on pulse pressure.

Key Words: pulse • atherosclerosis • women

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