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Titolo:
Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients
Autore:
Blacher, J; Staessen, JA; Girerd, X; Gasowski, J; Thijs, L; Liu, LS; Wang, JG; Fagard, RH; Safar, ME;
Indirizzi:
Catholic Univ Louvain, Dept Mol & Cardiovasc Res, Study Coordinating Ctr, Hypertens & Cardiovasc Rehabil Unit, B-3000 Louvain, Belgium Catholic Univ Louvain Louvain Belgium B-3000 it, B-3000 Louvain, Belgium Hop Broussais, Serv Med Interne, F-75674 Paris, France Hop Broussais Paris France F-75674 rv Med Interne, F-75674 Paris, France Cardiovasc Inst, Div Hypertens, Beijing, Peoples R China Cardiovasc Inst Beijing Peoples R China rtens, Beijing, Peoples R China Fuwai Hosp, Chinese Acad Med Sci, Beijing, Peoples R China Fuwai Hosp Beijing Peoples R China ad Med Sci, Beijing, Peoples R China Peking Union Med Coll, Beijing, Peoples R China Peking Union Med Coll Beijing Peoples R China Beijing, Peoples R China
Titolo Testata:
ARCHIVES OF INTERNAL MEDICINE
fascicolo: 8, volume: 160, anno: 2000,
pagine: 1085 - 1089
SICI:
0003-9926(20000424)160:8<1085:PPNMPD>2.0.ZU;2-S
Fonte:
ISI
Lingua:
ENG
Soggetto:
ISOLATED SYSTOLIC HYPERTENSION; CORONARY HEART-DISEASE; HIGH BLOOD-PRESSURE; MYOCARDIAL-INFARCTION; ACTIVE TREATMENT; MORTALITY; FRAMINGHAM; PREDICTOR; PLACEBO; TRIAL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
25
Recensione:
Indirizzi per estratti:
Indirizzo: Staessen, JA Catholic Univ Louvain, Dept Mol & Cardiovasc Res, Study Coordinating Ctr, Hypertens & Cardiovasc Rehabil Unit, Campus Gasthuisberg,Herestr 49, B-3000Louvain, Belgium Catholic Univ Louvain Campus Gasthuisberg,Herestr 49 Louvain Belgium B-3000
Citazione:
J. Blacher et al., "Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients", ARCH IN MED, 160(8), 2000, pp. 1085-1089

Abstract

Background: Current guidelines for the management of hypertension rest almost completely on the measurement of systolic and diastolic blood pressure. However, the arterial blood pressure wave is more correctly described as consisting of a pulsatile (pulse pressure) and a steady (mean pressure) component. Objective: To explore the independent roles of pulse pressure and mean pressure as determinants of cardiovascular prognosis in older hypertensive patients. Methods: This meta-analysis, based on individual patient data, pooled the results of the European Working Party on High Blood Pressure in the Elderlytrial (n = 840), the Systolic Hypertension in Europe Trial (n = 4695), andthe Systolic Hypertension in China Trial (n = 2394). The relative hazard rates associated with pulse pressure and mean pressure were calculated usingCox regression analysis, with stratification for the 3 trials and with adjustments for sex, age, previous cardiovascular complications, smoking, and treatmentResults: A 10-mm Hg wider pulse pressure increased the risk of major cardiovascular complications; after controlling for mean pressure and the other covariates, the increase in risk ranged from approximately 13% for all coronary end points (P = .02) to nearly 20% for cardiovascular mortality (P = .001). In a similar analysis, mean pressure predicted the incidence of cardiovascular complications but only after removal of pulse pressure as an explanatory variable from the model. Furthermore, the probability of a major cardiovascular end point increased with higher systolic blood pressure; at any given level of systolic blood pressure, it also increased with lower diastolic blood pressure, suggesting that the wider pulse pressure was driving the risk of major complications. Conclusions: In older hypertensive patients, pulse pressure not mean pressure is the major determinant of cardiovascular risk. The implications of these findings for the management of hypertensive patients should be further investigated in randomized controlled outcome trials in which the pulsatilecomponent of blood pressure is differently affected by antihypertensive drug treatment.

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Documento generato il 05/04/20 alle ore 22:35:10