Abstract 14147: The Non-Linear Relationship of Pulse Pressure to Mortality at the 22 year Follow-Up of the Systolic Hypertension in the Elderly Program
Introduction: An association of pulse pressure (PP) with mortality has been reported. However, scant data are available on long-term follow-up in placebo controlled clinical trials and on the shape of the relationship between PP and all-cause and cardiovascular (CV) death.
Hypothesis: We examined the relationship between PP with mortality at 22 years in the placebo and active treatment groups of the Systolic Hypertension in the Elderly Program (SHEP).
Methods: SHEP enrolled participants aged 60 and older (mean 72) with isolated systolic hypertension (systolic blood pressure 160 mm Hg or higher and diastolic blood pressure below 90 mm Hg). The relationship between all-cause and CV mortality with baseline PP was examined in 4,211 SHEP participants.
Results: A J curve relationship of mortality and PP was observed for all-cause death in an unadjusted analysis: linear term p<0.0001, quadratic term (green) p=0.01743 and tricubic (red). In this analysis highest risk was at a PP of 118 mm Hg (left figure). When the analysis was adjusted for age, gender, co-morbidities and risk factors for CV disease, the non-linear relationship was markedly attenuated with the quadratic term not statistically significant (right figure). Age (p<0.0001) and female gender (p=0.0215) were significant predictors of mortality. The effects on CV mortality were similar to those of all-cause mortality.
Conclusions: In patients with isolated systolic hypertension, there is a non-linear (quadratic) relationship between PP and all-cause and CV mortality at 22 years of follow-up. This relationship is primarily mediated by age, gender, co-morbidities and CV risk factors and is attenuated after adjustment.
Author Disclosures: J.B. Kostis: Research Grant; Modest; Bayer, AstraZeneca, Pfizer. Research Grant; Significant; Novartis, Sanofi. Consultant/Advisory Board; Modest; Sanofi-Aventis, Merck, Janssen. Consultant/Advisory Board; Significant; Palatin, St. Jude Medical. F. Wang: None. W.J. Kostis: None. D. Amaratunga: None. J.S. Pantazopoulos: None. J. Cabrera: None. F.H. Messerli: Consultant/Advisory Board; Modest; Daiichi-Sankyo, Pfizer, Abbott, Servier, Medtronic, WebMD, IPCA, ACC, Menarini, Relypsa.
- © 2015 by American Heart Association, Inc.