(Circulation. 1997;96:4254-4260.)
© 1997 American Heart Association, Inc.
Articles |
Sphygmomanometrically Determined Pulse Pressure Is a Powerful Independent Predictor of Recurrent Events After Myocardial Infarction in Patients With Impaired Left Ventricular Function
From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (G.F.M., E.B., M.A.P.); the University of Texas Health Science Center and the School of Public Health, Houston (L.A.M.); the Institut de Cardiologie de Montreal, Québec (J.-L.R.), the University of British Columbia, Vancouver, British Columbia (V.B.); Washington University School of Medicine, St Louis, Mo (E.M.G.); and the University of Missouri Health Science Center, Columbia (G.C.F.).
Correspondence to Gary F. Mitchell, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail gfmitchell{at}bics.bwh.harvard.edu
Background There is increasing evidence of a link between conduit vessel stiffness and cardiovascular events, although the association has never been tested in a large post–myocardial infarction patient population.
Methods and Results We evaluated the relationship between baseline pulse pressure, measured by sphygmomanometry 3 to 16 days after myocardial infarction, and subsequent adverse clinical events in the 2231 patients enrolled in the SAVE Trial. Increased pulse pressure was associated with increased age, left ventricular ejection fraction, female sex, history of prior infarction, diabetes, and hypertension and use of digoxin and calcium channel blockers. Over a 42-month period, there were 503 deaths, 422 cardiovascular deaths, and 303 myocardial infarctions. Pulse pressure was significantly related to each of these end points as a univariate predictor. In a multivariate analysis, pulse pressure remained a significant predictor of total mortality (relative risk, 1.08 per 10 mm Hg increment in pulse pressure; 95% CI, 1.00 to 1.17; P<.05) and recurrent myocardial infarction (relative risk, 1.12; 95% CI, 1.01 to 1.23; P<.05) after control for age; left ventricular ejection fraction; mean arterial pressure; sex; treatment arm (captopril or placebo); smoking history; history of prior myocardial infarction, diabetes, or hypertension; and treatment with ß-blockers, calcium channel blockers, digoxin, aspirin, or thrombolytic therapy.
Conclusions These data provide strong evidence for a link between pulse pressure, which is related to conduit vessel stiffness, and subsequent cardiovascular events after myocardial infarction in patients with left ventricular dysfunction.
Key Words: hemodynamics • arteriosclerosis • risk factors • atherosclerosis • aging
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M. O'Rourke and E. D. Frohlich Pulse Pressure : Is This a Clinically Useful Risk Factor? Hypertension, September 1, 1999; 34(3): 372 - 374. [Full Text] [PDF]
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M. J. Domanski, B. R. Davis, M. A. Pfeffer, M. Kastantin, and G. F. Mitchell Isolated Systolic Hypertension : Prognostic Information Provided by Pulse Pressure Hypertension, September 1, 1999; 34(3): 375 - 380. [Abstract] [Full Text] [PDF]
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S. S. Franklin, S. A. Khan, N. D. Wong, M. G. Larson, and D. Levy Is Pulse Pressure Useful in Predicting Risk for Coronary Heart Disease? : The Framingham Heart Study Circulation, July 27, 1999; 100(4): 354 - 360. [Abstract] [Full Text] [PDF]
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M. J. Domanski, G. F. Mitchell, J. E. Norman, D. V. Exner, B. Pitt, and M. A. Pfeffer Independent prognostic information provided by sphygmomanometrically determined pulse pressure and mean arterial pressure in patients with left ventricular dysfunction J. Am. Coll. Cardiol., March 15, 1999; 33(4): 951 - 958. [Abstract] [Full Text] [PDF]
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G. de Simone, M. J. Roman, M. J. Koren, G. A. Mensah, A. Ganau, and R. B. Devereux Stroke Volume/Pulse Pressure Ratio and Cardiovascular Risk in Arterial Hypertension Hypertension, March 1, 1999; 33(3): 800 - 805. [Abstract] [Full Text] [PDF]
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C. U. Chae, M. A. Pfeffer, R. J. Glynn, G. F. Mitchell, J. O. Taylor, and C. H. Hennekens Increased Pulse Pressure and Risk of Heart Failure in the Elderly JAMA, February 17, 1999; 281(7): 634 - 643. [Abstract] [Full Text] [PDF]
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 N. Stergiopulos, P. Segers, and N. Westerhof Use of pulse pressure method for estimating total arterial compliance in vivo Am J Physiol Heart Circ Physiol, February 1, 1999; 276(2): H424 - H428. [Abstract] [Full Text] [PDF]
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A. Benetos, A. Rudnichi, F. Thomas, M. Safar, and L. Guize Influence of Heart Rate on Mortality in a French Population : Role of Age, Gender, and Blood Pressure Hypertension, January 1, 1999; 33(1): 44 - 52. [Abstract] [Full Text] [PDF]
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P. Verdecchia, G. Schillaci, C. Borgioni, A. Ciucci, S. Pede, and C. Porcellati Ambulatory Pulse Pressure : A Potent Predictor of Total Cardiovascular Risk in Hypertension Hypertension, December 1, 1998; 32(6): 983 - 988. [Abstract] [Full Text] [PDF]
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C.-H. Chen, M. Nakayama, E. Nevo, B. J. Fetics, W. L. Maughan, and D. A. Kass Coupled systolic-ventricular and vascular stiffening with age: Implications for pressure regulation and cardiac reserve in the elderly J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1221 - 1227. [Abstract] [Full Text] [PDF]
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N. Stergiopulos and N. Westerhof Determinants of Pulse Pressure Hypertension, September 1, 1998; 32(3): 556 - 559. [Abstract] [Full Text] [PDF]
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A. Benetos, A. Rudnichi, M. Safar, and L. Guize Pulse Pressure and Cardiovascular Mortality in Normotensive and Hypertensive Subjects Hypertension, September 1, 1998; 32(3): 560 - 564. [Abstract] [Full Text] [PDF]
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