Carotid (C) pulse pressure (PP) is constantly lower than brachial (B) PP, but is a more powerful predictor of CV risk than B-PP. The C/B-PP ratio is marker of PP amplification. The objective was to explore whether the role of C/B-PP ratio for all-cause and CV mortality is different between men and women.

Population was composed of 72,437 men (41.0±11.1 years) and 52,714 women (39.5±11.6 years) with similar mean arterial pressure. C-PP was calculated in both genders from a validated equation. The hazard ratios (HR, 95% CI) associated with C/B ratio for all-cause and cardiovascular (CV) mortality were calculated with Cox regression models according to age and gender. The age threshold of 55 years was chosen to study the role of menopause. During a 12-year follow-up, 3028 men and 969 women died.

The adjusted risk (HR) associated with C/B ratio for all-cause mortality was 1.51 (1.47–1.56) in men and 2.46 (2.27–2.67) (p<0.0001) in women; for CV mortality it was 1.81 (1.70–1.93) and 4.46 (3.66–5.45) (p<0.0001), respectively. The difference between genders for CV mortality increased after 55 years of age, from 1.44 (1.31–1.58) for men vs 3.19 (2.08–4.89) for women <55 years, to 1.65 (1.48–1.84) for men vs 5.60 (4.17–7.50) for women ≥55 years. Over 55 years, impact of C/B ratio was highly significant in men and women (p<0.0001).

C/B-PP amplification is highly predictive of differences in CV risk between men and women. Among women, after menopause, the attenuation of amplification associated with aortic stiffness strongly contributes to increasing cardiovascular risk.