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 4663 young (18-49 years) and 7185 older adults (≥50 years), brachial PP was recorded over 24-hour. Total mortality and all major cardiovascular events combined (MACE) were co-primary endpoints. Cardiovascular death, coronary events and stroke were secondary endpoints.
RESULTS In young adults (median follow-up, 14.1 years; mean PP, 45.1 mmHg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1000 person-years. The adjusted hazard ratios expressed per 10-mmHg PP increments were less than unity (P≤0.027) for MACE (0.67; 95% 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 mmHg), the endpoint rates, expressing absolute risk, ranged from 22.5 to 45.4 per 1000 person-years and the adjusted hazard ratios, reflecting relative risk, from 1.09 to 1.54 (P3-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
Jesus D Melgarejo, Lutgarde Thijs, Dong-Mei Wei, Michael Bursztyn, Wen-Yi Yang, Yan Li, Kei Asayama, Tine W Hansen, Masahiro Kikuya, Takayoshi Ohkubo, Eamon Dolan, Katarzyna Stolarz-Skrzypek, Yi-Bang Cheng, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Lars Lind, Edgardo Sandoya, Jan Filipovský, Krzysztof Narkiewicz, Natasza Gilis-Malinowska, Kalina Kawecka-Jaszcz, José Boggia, Ji-Guang Wang, Yutaka Imai, Peter Verhamme, Sander Trenson, Stefan Janssens, Eoin O’Brien, Gladys E Maestre, Benjamin Gavish, Jan A Staessen, Zhen-Yu Zhang, The International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome Investigators, Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor, American Journal of Hypertension, Volume 34, Issue 9, September 2021, Pages 929–938, https://doi.org/10.1093/ajh/hpab048
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