Reference frame for home pulse pressure based on cardiovascular risk in 6470 subjects from 5 populations

Lucas S. Aparicio, Lutgarde Thijs, Kei Asayama, Jessica Barochiner, José Boggia, Yu Mei Gu, Paula E. Cuffaro, Yan Ping Liu, Teemu J. Niiranen, Takayoshi Ohkubo, Jouni K. Johansson, Masahiro Kikuya, Atsushi Hozawa, Ichiro Tsuji, Yutaka Imai, Edgardo Sandoya, George S. Stergiou, Gabriel D. Waisman, Jan A. Staessen

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12 Citations (Scopus)


The absence of an outcome-driven reference frame for self-measured pulse pressure (PP) limits its clinical applicability. In an attempt to derive an operational threshold for self-measured PP, we analyzed 6470 participants (mean age 59.3 years; 56.9% women; 22.5% on antihypertensive treatment) from 5 general population cohorts included in the International Database on HOme blood pressure in relation to Cardiovascular Outcome. During 8.3 years of follow-up (median), 294 cardiovascular deaths, 393 strokes and 336 cardiac events occurred. In 3285 younger subjects (<60 years), home PP only predicted all-cause and cardiovascular mortality (P≤0.036), whereas in 3185 older subjects (≥60 years) PP predicted total and cardiovascular mortality (P≤0.0067) and all cardiovascular and coronary events (P≤0.044). However, PP did not substantially refine risk prediction based on classical risk factors including mean blood pressure (generalized R 2 statistic ≤0.20%). In older subjects, the adjusted hazard ratios expressing the risk in the upper decile of home PP (≥76 mm Hg) versus the average risk in whole population were 1.41 (95% confidence interval, 1.09-1.81; P=0.0081) for all-cause mortality, 1.62 (1.11-2.35; P=0.012) for cardiovascular mortality and 1.31 (1.00-1.70; P=0.047) for all fatal and nonfatal cardiovascular end points combined. The low number of events precluded an analysis by tenths of the PP distribution in younger participants. In conclusion, a home PP of ≥76 mm Hg predicted cardiovascular outcomes in the elderly with the exception of stroke, whereas in younger subjects no threshold could be established.

Original languageEnglish
Pages (from-to)672-678
Number of pages7
JournalHypertension Research
Issue number7
Publication statusPublished - 2014 Jul


  • cardiovascular diseases
  • epidemiology
  • home blood pressure
  • pulse pressure
  • thresholds


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