A3205 Different role of elevated pulse pressure according to gender in a cohort of young to middle age stage I hypertensives

Abstract

Objectives: Elevated pulse pressure (PP) is a major risk factor in the elderly, while little is known about its clinical significance in the young and according to gender. We investigated the predictive role of elevated PP in young male and female stage 1 hypertensives. Methods: We examined 877 men and 329 women (mean age 33.1 ± 8.5 years) from the HARVEST Study, divided into tertiles of PP and mean blood pressure (MBP). The risk of development of hypertension needing treatment (HT) and cardiovascular events (CVE), according to pressure tertiles, was assessed by multivariate Cox analysis. Results: Significant determinants of PP among men were: younger age (P < 0.001), physical activity (P = 0.048), heart rate (P = 0.013), systolic white coat effect (P < 0.001) and stroke volume (n = 617; P < 0.001); among women only older age (P = 0.009), heart rate (P = 0.005) and systolic white coat effect (P < 0.001). During follow-up (12.1 years), 63.8% of men and 68.4% of women developed HT and 8.5% and 5.5 %, respectively, had a CVE. Males in the highest PP tertile had a reduced risk of incident HT compared to those in the bottom tertile (HR 0.74; 95% CI (0.59–0.93); P = 0.009), while participants in the top MBP tertile had an increase in risk (1.93 (1.54–2.43); P < 0.001). The top MBP tertile had a positive association with HT also among women (1.85 (1.24–2.78); P = 0.003) but no association was found for PP in female gender. Similar results were observed for CVE. Men in the top PP tertile had a reduced risk (0.45 (0.22–0.94; P = 0.003) and those in the top MBP tertile had an increased risk (3.56 (1.42–8.91; P = 0.007). Among women, neither PP nor MBP were significant predictors of CVE. Conclusion: Our data show that in young subjects MBP was a predictor of adverse outcome in both genders, while PP showed a protective role for both outcome only in men.