Abstract 11669: Pulse Pressure and Risk of Cardiovascular Events in Patients With Atherothrombosis: Findings From the REACH Registry
Background: Pulse pressure (PP) provides valuable prognostic information in specific populations, but few studies have assessed its prognostic value on cardiovascular outcomes in a broad, worldwide population.
Hypothesis: PP is associated with adverse outcomes independent of mean arterial pressure.
Methods: We examined participants from the REACH (Reduction of Atherothrombosis for Continued Health) registry, an international study of individuals with atherothrombotic disease or risk factors for its development. We excluded those with incomplete four-year follow-up or PP data (final N=45,087). Univariable and multivariable regression analyses (using stepwise modeling) were performed to determine the association between PP and cardiovascular outcomes, including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, cardiovascular hospitalization, and a combined outcome. Model 1 covariates included sex, age, smoking status, hyperlipidemia, diabetes mellitus, aspirin use, statin use. Model 2 further adjusted for history of atherothrombosis. Model 3 additionally adjusted for blood pressure medications. Model 4 finally adjusted for mean arterial pressure.
Results: The mean age of the cohort was 68±10 years, 35% were female, and 81% were treated for hypertension. The mean blood pressure was 138±19/79±11 mmHg (mean PP of 49±16 mmHg). On univariable analysis, increasing PP quartile was associated with worse outcomes (p<0.05 for all comparisons). The Figure displays hazard ratios per 10 mmHg increase in PP, and shows an increased risk of the combined outcome. Similar findings were demonstrated for non-fatal myocardial infarction and cardiovascular hospitalization (p<0.01).
Conclusions: In a large international cohort of high-risk individuals, PP, a readily available hemodynamic parameter, is associated with multiple adverse cardiovascular outcomes and provides prognostic utility beyond that of mean arterial pressure.
Author Disclosures: S. Selvaraj: None. P. Steg: Research Grant; Significant; research grant from sanofi-aventis and Servier awarded to INSERM U-698 and the New York University School of Medicine. Consultant/Advisory Board; Significant; Ablynx, Amarin, Amgen, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Meyers Squibb, Daiichi Sankyo, Eisai, GlaxoSmithKline, Lilly,Medtronic, Merck Sharp & Dohme, Novartis, Otsuka, Pfizer, Roche, Sanofi-Aventis, Servier, the Medicines Company. Other; Significant; holding stock in Aterovax. Y. Elbez: None. E. Sorbets: None. L.J. Feldman: Research Grant; Significant; research grants from Sanofi-Aventis and Bristol-Myers Squibb. K. Eagle: None. E. Ohman: None. J. Blacher: Research Grant; Significant; Servier. Speakers Bureau; Significant; Astra-Zeneca, Bayer, BMS, Bouchara Recordati, Daïchii Sankyo, GSK, Ipsen, Menarini, Merck Serono, MSD, Novartis, Pileje, Roche, Sanofi, Servier and Takeda. D. Bhatt: Research Grant; Significant; Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company;. Honoraria; Significant; American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute, Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology, Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), WebMD (CME steering committees), Clinical Cardiology (Deputy Editor). Consultant/Advisory Board; Significant; Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, Chair: American Heart Association Get With The Guidelines Steering Committee; Data Monitoring Committees: Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute.
- © 2015 by American Heart Association, Inc.