Abstract 18403
Pulse Pressure and all Cause Mortality among Treated Hypertensives
- Papademetriou, Vasilios
- Amdur, Richard
- Faselis, Charles Faselis
- Doumas, Michael Doumas
- Tsioufis, Costas
- Fletcher, Ross D
Introduction: Wide pulse pressure (systolic minus diastolic, PP) identifies patients with increased arterial stiffness and predicts increased cardiovascular risk. However the optimal PP among treated hypertensives has not been determined
Methods: We examine mortality rates in 460,460 patients (age 18–90 years) with hypertension from 15 Veterans Administration hospitals followed from January 2000 to December 2007. Patients with systolic BP <100 were excluded from this analysis. Mortality rates were assessed for each 10 mmHg increments of PP measured at the last visit.
Results: During the follow up period blood pressure control (<140/90 mmHg) improved from 44% in the year 2000 to 73% (P<0.001) by the end of the year 2007. During the 7 year follow up period a total of 63,717 patients died. Based on achieved SBP the lowest mortality rate(9.8%) was noted in patients with SBP=130–139 mmHg. Achieved SBP lower than 129 or higher than 140 mmHg was associated with increased mortality. In this population the optimal PP was 50–59 with a mortality rate of 11.8%. Similar mortality rates were note with PP of 40–49 (12.3%0 and PP 60–69 (12.9%). Higher or lower PP was associated with increased mortality (see figure). The very low PP probably identifies patients with severe LV dysfunction and the very high PP identifies patients with uncontrolled hypertension.
Conclusions: These data indicate that: 1) Optimal target for systolic blood should be 130–139 mmHg for most patients, 2) Among treated hypertensives PP is a strong predictor of mortality, but mortality patterns follow a U shape curve, 3)The Optimal PP range is 40–70 mmHg
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