Abstract P178: Age-Related Gender and Ethnic Variations of Pulse Pressure and Pulsatile Stress

Abstract

Background: Aging causes significant widening of pulse pressure (PP), which has been associated with increased incidence of heart failure, especially diastolic with preserved ejection fraction (HFpEF). Pulsatile stress (PS; the product of PP and heart rate, HR) is a measure of the pulsatile load (per minute) on the cardiovascular system of the beat-to-beat PP, also associated with negative outcomes. Methods: Encounters from university-based cardiology clinic with broad referral base were analyzed; 400 encounters were reviewed for PP and PS; with a total of 100 in each of the categories (WM, WF, AAM and AAF). Each group was individually analyzed for PP and PS in young patients (Young; < 60 years of age) versus old patients (Old; ≥ 60 years of age), using a Student’s t-test. PP is reported in mmHg, PS in mmHg/min (PP in mmHg x HR in beats per minute) and mean age in each category is reported in years. Results: PP in Young WM (mean age 50; n = 41) was 48 ± 15 mmHg, and in Old WM (mean age 69; n = 59) was 55 ± 19 mmHg (7 mmHg difference; P = NS). PS in Young WM was 3395 ±1158 mmHg/min, and in Old WM was 3805 ± 1386 mmHg/min (410 mmHg difference; P = NS). PP in Young WF (mean age 52; n = 27) was 45 ± 9 mmHg, and in Old WF (mean age 70; n = 73) was 59 ± 21 mmHg (14 mmHg difference; P < 0.05). PS in Young WF was 3319 ± 891 mmHg/min, and in Old WF was 4159 ± 1486 mmHg/min (840 mmHg difference; P <0.05). PP in Young AAM (mean age 50; n = 47) was 51 ± 14 mmHg, and in Old AAM (mean age 70; n = 53) was 56 ± 17 mmHg (6 mmHg difference; P = NS). PS in Young AAM was 3623 ± 1102 mmHg/min, and in Old AAM was 3855 ± 1447 mmHg/min (232 mmHg difference; P = NS). PP in Young AAF (mean age 48; n = 42) was 50 ± 18 mmHg, and in Old AAF (mean age 68; n = 58) was 58 ± 21 mmHg (8 mmHg difference; P < 0.05). PS in Young AAF was 3760 ± 1441 mmHg/min, and in Old AAF 4043 ± 1638 mmHg/min (283 mmHg difference; P= NS). Conclusion: The elderly suffer from mostly isolated systolic hypertension , with elevated pulse pressure, an independent predictor of cardiac events. Here, PP was higher in elderly compared with young patients, but the increase was significant only in females. PS was non-significantly changed with age in males. In females PS became non-significantly changed with age in AAF, but was statistically higher in older WF. These differences may help explain the increased incidence of HFpEF in older women compared to men and older white patients compared to blacks. The reason for this variation is unclear, but may be in part related to post-menopausal hormonal changes in older females. These observations are important as they identify significant gender and ethnic-related changes in pulse pressure and pulsatile stress with age affecting females, especially white females, who have elevated cardiovascular risk post-menopause.