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Increased Pulse Pressure and Risk of Heart Failure in the Elderly

1999; American Medical Association; Volume: 281; Issue: 7 Linguagem: Inglês

10.1001/jama.281.7.634

1538-3598

Claudia U. Chae,

Heart Rate Variability and Autonomic Control

Context Arterial stiffness increases with age.Thus, pulse pressure, an index of arterial stiffening, may predict congestive heart failure (CHF) in the elderly. ObjectiveTo study prospectively the association between pulse pressure and risk of CHF.Design Prospective cohort study. SettingThe community-based East Boston Senior Health Project, East Boston, Mass.Patients A total of 1621 men and women (mean [SD] age, 77.9 [5.0] years) free of CHF who had blood pressure measurements taken in 1988-1989 and were followed up for 3.8 years.Main Outcome Measure Incidence of CHF as ascertained by hospital discharge diagnosis (n = 208) and death certificates (n = 13). ResultsAfter controlling for age, sex, mean arterial pressure, history of coronary heart disease, diabetes mellitus, atrial fibrillation, valvular heart disease, and antihypertensive medication use, pulse pressure was an independent predictor of CHF.For each 10-mm Hg elevation in pulse pressure, there was a 14% increase in risk of CHF (95% confidence interval, 1.05-1.24;P = .003).Those in the highest tertile of pulse pressure (Ͼ67 mm Hg) had a 55% increased risk of CHF (P = .02)compared with those in the lowest (Ͻ54 mm Hg).Pulse pressure was more predictive than systolic blood pressure alone and was independent of diastolic blood pressure. ConclusionPulse pressure, an easily measurable correlate of pulsatile hemodynamic load, is an independent predictor of risk of CHF in this elderly cohort.