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04-08-2013 | Cardiology | Article

Multiple BP components give better vascular risk picture

Abstract

Free abstract

medwireNews: Considering just one component of blood pressure (BP) may give an incomplete picture of a person’s cardiovascular risk, study findings suggest.

BP measures correlated strongly with each other, yet their individual associations with cardiovascular outcomes varied, report Susan Cheng (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and team.

“With respect to potential clinical implications, our findings underscore the importance of assessment and management of multiple BP components,” they write in Hypertension.

The researchers used data from 13,340 participants of the Atherosclerosis Risk In Communities study who had no cardiovascular disease at baseline. During an average of 22 years of follow up, 2095 participants had a coronary heart disease (CHD) event, 1669 had a heart failure (HF) event, 771 had a stroke, and 3016 died.

HF and death increased “substantially more” with small rises in pulse pressure (PP) than in systolic BP (SBP), with the highest incidence rates of these events seen among people in the top quartile of PP, at 6.40 and 12.57 events per 1000 person–years. The corresponding rates among those in the top SBP quartile were 6.24 and 12.49 per 1000 person–years.

Likewise, the largest area under the receiver operating characteristic curve (ROC) for HF and death was achieved with PP, at 0.786 and 0.742, respectively.

“Taken together with previous reports, our overall findings suggest that conduit artery stiffening, manifesting as elevated PP, is likely part of the common pathway leading to the development of HF in a majority of individuals at risk,” the team comments.

Stroke, by contrast, was strongly linked to SBP, with an incidence rate of 4.34 per 1000 person–years among people in the top quartile and an area under the ROC of 0.744. CHD events appeared to increase by a similar degree with both SBP and PP; however, the highest incidence rate was seen in the top SBP quartile, at 10.41 per 1000 person–years. SBP also produced the largest area under the ROC, of 0.738.

The team also looked at diastolic BP and mean arterial pressure, but these contributed less to outcomes than did SBP and PP.

“Our data provide further insights about the distinct hemodynamic pathways by which different forms of BP elevation may contribute to the development of different cardiovascular disease end points,” concludes the team.

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter

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