Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor-Reference-Cited by-同舟云学术

Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor

Published:2021-03-04 Issue:9 Volume:34 Page:929-938
ISSN:0895-7061
Container-title:American Journal of Hypertension
language:en
Short-container-title:

Author:

Melgarejo Jesus D¹²,Thijs Lutgarde¹,Wei Dong-Mei¹,Bursztyn Michael³,Yang Wen-Yi⁴,Li Yan⁵,Asayama Kei⁶⁷,Hansen Tine W⁸,Kikuya Masahiro⁶,Ohkubo Takayoshi⁶⁷,Dolan Eamon⁹,Stolarz-Skrzypek Katarzyna¹⁰,Cheng Yi-Bang⁵,Tikhonoff Valérie¹¹,Malyutina Sofia¹²,Casiglia Edoardo¹¹,Lind Lars¹³^ORCID,Sandoya Edgardo¹⁴,Filipovský Jan¹⁵,Narkiewicz Krzysztof¹⁶,Gilis-Malinowska Natasza¹⁶,Kawecka-Jaszcz Kalina¹⁰,Boggia José¹⁷,Wang Ji-Guang⁵,Imai Yutaka⁷,Verhamme Peter¹⁸,Trenson Sander¹⁹^ORCID,Janssens Stefan¹⁹,O’Brien Eoin²⁰,Maestre Gladys E²²¹²²²³,Gavish Benjamin²⁴,Staessen Jan A²⁵²⁶^ORCID,Zhang Zhen-Yu¹

Affiliation:

1. Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium

2. Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Zulia, Venezuela

3. Faculty of Medicine, Hebrew University, Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

4. Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

5. Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

6. Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan

7. Tohoku Institute for Management of Blood Pressure, Sendai, Japan

8. Steno Diabetes Center Copenhagen, Gentofte and Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark

9. Stroke and Hypertension Unit, Blanchardstown, Dublin, Ireland

10. First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland

11. Department of Medicine, University of Padova, Padova, Italy

12. Institute of Internal and Preventive Medicine, Internal and Preventive Medicine—Branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science, Novosibirsk, Russian Federation

13. Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

14. Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay

15. Faculty of Medicine, Charles University, Pilsen, Czech Republic

16. Department of Hypertension, Medical University of Gdańsk, Gdańsk, Poland

17. Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay

18. Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium

19. Division of Cardiology, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium

20. Conway Institute, University College Dublin, Dublin, Ireland

21. Department of Neurosciences, University of Texas Rio Grande Valley School of Medicine, Brownsville, Texas, USA

22. Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, Texas, USA

23. Alzheimer’s Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, Texas, USA

24. Yazmonit Ltd., Jerusalem, Israel

25. Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium

26. Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium

Abstract

Abstract Background Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan. Methods In 4,663 young (18–49 years) and 7,185 older adults (≥50 years), brachial PP was recorded over 24 hours. Total mortality and all major cardiovascular events (MACEs) combined were coprimary endpoints. Cardiovascular death, coronary events, and stroke were secondary endpoints. Results In young adults (median follow-up, 14.1 years; mean PP, 45.1 mm Hg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1,000 person-years. The adjusted hazard ratios expressed per 10-mm Hg PP increments were less than unity (P ≤ 0.027) for MACE (0.67; 95% confidence interval [CI], 0.47–0.96) and cardiovascular death (0.33; 95% CI, 0.11–0.75). In older adults (median follow-up, 13.1 years; mean PP, 52.7 mm Hg), the endpoint rates, expressing absolute risk, ranged from 22.5 to 45.4 per 1,000 person-years and the adjusted hazard ratios, reflecting relative risk, from 1.09 to 1.54 (P < 0.0001). The PP-related relative risks of death, MACE, and stroke decreased >3-fold from age 55 to 75 years, whereas absolute risk rose by a factor 3. Conclusions From 50 years onwards, the PP-related relative risk decreases, whereas absolute risk increases. From a lifecourse perspective, young adulthood provides a window of opportunity to manage risk factors and prevent target organ damage as forerunner of premature death and MACE. In older adults, treatment should address absolute risk, thereby extending life in years and quality.

Funder

European Union

European Research Council

European Research Area Net for Cardiovascular Diseases

Ministry of the Flemish Community, Brussels, Belgium

National Natural Science Foundation of China

Ministry of Science and Technology

Shanghai Commissions of Science and Technology

Shanghai Bureau of Health

Charles University Research Fund

Danish Heart Foundation

Lundbeckfonden