781-4 Relation of Pulse Pressure to Target Organ Damage in Hypertensive Patients

Abstract

Wide arterial pulse pressure has been previously reported to reflect changes in arterial structure and stiffness and predicts myocardial infarction in hypertensive patients. Ultrasonic detection of carotid atherosclerosis also predicts subsequent myocardial infarction. To determine the relation of pulse pressure to the presence of target organ damage, as “preclinical” anatomic and functional cardiovascular disease, 198 asymptomatic, unmedicated hypertensive subjects underwent ultrasonographic evaluation of left ventricular (LV) and extracranial carotid artery structure and function. Vascular stiffness was also evaluated by simultaneous applanation tonometry of the contralateral carotid artery pressure waveform. Based on the 97 th percentile of pulse pressure in 324 normotensive adults (70 mmHg), patients were divided into groups with higher (≥ 70 mmHg, group 1, n = 55) or lower (< 70 mmHg, group 2, n = 143) pulse pressures. Higher pulse pressure was associated with older age (67 ± 10 vs 52 ± 10 years, p < 0.0001), female gender (53 vs 30%, p < 0.005) and higher LV mass indexed by body surface area (96 ± 21 vs 89 ± 19 g/m2, p < 0.05) or height 2.7 (44 ± 9 vs 40 ± 9 g/m 2.7 , p < 0.01) as well as with increased end-systolic stress (80 ± 24 vs 72 ± 19 dynes/cm2 x 103, P < 0.05) and arterial stiffness (Peterson's elastic modulus = 667 ± 323 vs 452 ± 192 dynes/cm 2 x to-6, p < 0.0001). The differences in LV mass and arterial stiffness persisted after adjusting for the effect of age and gender but became insignificant in analysis of covariance after adjusting for mean arterial pressure. The prevalence of isolated systolic hypertension was higher in the group with pulse pressure ≥ 70 mmHg (29 vs 2%, p < 0.0001). The prevalence of discrete or diffuse carotid atherosclerosis was two-fold increased in group 1 (49 vs 25%, p < 0.005) as was the prevalence of LV hypertrophy (LV masslbody surface area, 27 vs 13%, p < 0.05). The two groups had similar serum lipid levels and smoking history. Logistic regression analysis indicated that age, mean arterial pressure and the presence of atherosclerosis — but not gender or LV mass — were independently associated with higher pulse pressure. The present findings suggest that higher mean BP mediates the relation of high pulse pressure to changes in cardiac structure and arterial stiffness in hypertensive patients. However, the independent relation of carotid atherosclerosis with higher arterial pulse pressure confirms the prognostic relevance of higher levels of pulse pressure.