This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: May 26, 2009, Volume 119, Number 20 All Versions of this Article: 119/20/2663    most recent CIRCULATIONAHA.108.838698v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lam, C. S.P. Articles by Redfield, M. M. Search for Related Content PubMed PubMed Citation Articles by Lam, C. S.P. Articles by Redfield, M. M. Pubmed/NCBI databases Medline Plus Health Information High Blood Pressure Seniors' Health Related Collections Pulmonary circulation and disease Epidemiology Related Articles

(Circulation. 2009;119:2663-2670.)
© 2009 American Heart Association, Inc.

Epidemiology

Age-Associated Increases in Pulmonary Artery Systolic Pressure in the General Population

Carolyn S.P. Lam, MBBS, MRCP; Barry A. Borlaug, MD; Garvan C. Kane, MD, PhD; Felicity T. Enders, PhD; Richard J. Rodeheffer, MD; Margaret M. Redfield, MD

From the Division of Cardiovascular Diseases (C.S.P.L., B.A.B., G.C.K., R.J.R., M.M.R.) and Department of Health Sciences Research (F.T.E.), Mayo Clinic and Foundation, Rochester, Minn, and Yong Loo Lin School of Medicine, Singapore (C.S.P.L.).

Correspondence to Margaret M. Redfield, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail redfield.margaret{at}mayo.edu

Received November 25, 2008; accepted March 2, 2009.

Background— In contrast to the wealth of data on isolated systolic hypertension involving the systemic circulation in the elderly, much less is known about age-related change in pulmonary artery systolic pressure (PASP) and its prognostic impact in the general population. We sought to define the relationship between PASP and age, to evaluate which factors influence PASP, and to determine whether PASP is independently predictive of mortality in the community.

Methods and Results— A random sample of the Olmsted County, Minn, general population (n=2042) underwent echocardiography and spirometry and was followed up for a median of 9 years. PASP was measured from the tricuspid regurgitation velocity. Left ventricular diastolic pressure was estimated with Doppler echocardiography (E/e' ratio), and arterial stiffening was assessed from the brachial artery pulse pressure. Among 1413 subjects (69%) with measurable PASP (age, 63±11 years; 43% male), median PASP was 26 mm Hg (25th to 75th percentile, 24 to 30 mm Hg) and increased with age (r=0.31, P<0.001). Independent predictors of PASP were age, pulse pressure, and mitral E/e' (all P0.003). Increasing PASP was associated with higher mortality (hazard ratio, 2.73 per 10 mm Hg; P<0.001). In subjects without cardiopulmonary disease (any heart failure, coronary artery disease, hypertension, diabetes mellitus, or chronic obstructive lung disease), the age-adjusted hazard ratio was 2.74 per 10 mm Hg (P=0.016).

Conclusions— We provide the first population-based evidence of age-related increase in pulmonary artery pressure, its association with increasing left heart diastolic pressures and systemic vascular stiffening, and its negative impact on survival. Pulmonary artery pressure may serve as a novel cardiovascular risk factor and potential therapeutic target.

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