2.6 THE NONLINEAR COMPONENTS OF PULSE PRESSURE: NOVEL MARKERS FOR ARTERIAL STIFFENING WITH PROGNOSTIC SIGNIFICANCE

DOI

10.1016/j.artres.2013.10.012How to use a DOI?

Abstract

Mean ambulatory pulse pressure (PP) is a potent predictor of cardiovascular and all-cause mortality.

Objectives. Investigating prognostic significance of elastic and non-elastic PP components

Methods. Using a generalized nonlinear pressure–volume relationship in arteries (Fig. 1), PP can be split into an elastic component (PPel) with constant (diastolic) arterial stiffness and a non-elastic component (PPnel) that reflects arterial stiffening during the systole. We determined PPnel, PPel and the ratio WIF=PPnel/PPel (‘Widening Factor’) from 24-hour ambulatory BP measurements (ABPM) using a model. Standardized hazard ratios (HR) were estimated with Cox proportional hazards regression adjusted to age, gender, body mass index, mean arterial pressure, heart period (HP), systolic- and heart rate-dipping and diabetes and medication status. Assuming an exponential P-V relationship, the model provides the expression WIF=[(K-1)/ln(K)]-1, where K=SD(SBP)/SD(DBP) (SD=standard deviation) and PPel=PP/(1+WIF)

Results. ABPM records of 2,105 individuals followed for 5 years for all-cause mortality were analyzed (age 56 ± 16, 55% women, 60% on medication and 9% diabetes, 115 died). Predictive power was demonstrated for patients with slower-than-median pulse rate (HP>0.87 s, n = 78): Mean(95%CI) HR of PPnel and WIF were 1.46(1.13–1.90) and 1.64(1.16–2.33) (P ≤ 0.005), respectively, and 1.59(1.21–2.1) and 1.83(1.27–2.63) (P = 0.001) for its subpopulation of older-than-median-age (>58 y, n = 73). The corresponding HR for PP was 1.34(1.03–1.75) (P = 0.03) and 1.53(1.15–2.03) (P = 0.004), respectively. PPel did not display predictive power. Fig. 2 shows that WIF varied strongly with age

Conclusion. The 24-hour non-elastic PP component and the Widening Factor, which reflects arterial stiffening during the systole, are novel predictors for mortality, especially in elderly patients with slower pulse.

Open Access

This is an open access article distributed under the CC BY-NC license.

TY  - JOUR
AU  - B. Gavish
AU  - M. Bursztyn
PY  - 2013
DA  - 2013/11/11
TI  - 2.6 THE NONLINEAR COMPONENTS OF PULSE PRESSURE: NOVEL MARKERS FOR ARTERIAL STIFFENING WITH PROGNOSTIC SIGNIFICANCE
JO  - Artery Research
SP  - 164
EP  - 164
VL  - 7
IS  - 3-4
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2013.10.012
DO  - 10.1016/j.artres.2013.10.012
ID  - Gavish2013
ER  -