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High Pulse Pressure May Help Identify Young Hypertensives At Higher Risk Of Cardiovascular Events
A DGReview of :"Pulse pressure and subclinical cardiovascular damage in primary hypertension."
Nephrology Dialysis Transplantation
10/02/2002
By Andrew A. Skolnick
High pulse pressure is an independent marker that may help identify younger patients with subclinical hypertension who are at higher risk of cardiovascular events.
High pulse pressure values have recently been implicated in the development and progression of large vessel atherosclerosis, small vessel disease and in the occurrence of cardiovascular events.
Francesca Viazzi and colleagues at the University of Genoa, in Genoa, Italy, investigated the relationship between high pulse pressure and subclinical cardiovascular damage in a cohort of middle-aged patients, with untreated primary hypertension, 204 of whom were male and 129 female.
The researchers calculated high pulse pressure as the difference between systolic and diastolic blood pressure. They assessed left ventricular mass index by M-B mode echocardiography and carotid intima-media thickness by high-resolution ultrasound scan. Albuminuria was measured as albumin-to-creatinine ratio in three non-consecutive first morning urine samples.
The investigators found that high pulse pressure was positively correlated with age, gender, disease duration, LDL serum cholesterol levels and to early signs of target organ damage - namely left ventricular mass index, intima-media thickness and albumin-to-creatinine ratio.
Patients in the upper quartile of high pulse pressure showed higher left ventricular mass index, thicker carotid walls and higher albumin to creatine ratio. Multiple linear regression analysis showed that high pulse pressure and albumin-to-creatine ratio independently influenced left ventricular mass index and intima-media thickness, the researchers reported.
Patients with left ventricular hypertrophy, increased carotid intima-media thickness and microalbuminuria showed greater high pulse pressure values compared with those with lesser degrees of target organ involvement. Moreover, the risk of having the simultaneous occurrence of various signs of target organ damage increased significantly with each standard deviation increase in high pulse pressure or systolic blood pressure, but was not influenced by diastolic blood pressure.
"High pulse pressure is an independent marker of preclinical cardiovascular damage in relatively young patients with primary hypertension and, therefore, can be useful for identifying those at higher risk of cardiovascular events," the authors concluded.
Nephrol Dial Transplant 2002; 17: 1779-1785
"Pulse pressure and subclinical cardiovascular damage in primary hypertension."
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