Brachial pulse pressure in heart failure: simple to measure but complex to interpret.

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This editorial refers to ‘Differing prognostic value of pulse pressure in patients with heart failure with reduced or preserved ejection fraction. Results from the MAGGIC individual patient meta-analysis’ by C.E. Jackson et al. , doi:10.1093/eurheartj/ehu490. Increased arterial stiffness is expected to affect cardiac work unfavourably and to have a detrimental effect on prognosis, especially in patients with heart failure (HF). Brachial pulse pressure (PP) has been used as a marker of arterial elastic properties to assess the effect of vascular dysfunction on target organ damage and thus to predict adverse outcome.1–6 Should PP, a crude surrogate marker of arterial stiffness, be proven to have prognostic value in patients with HF, then clinicians would be provided with a valuable, easy-to-measure, low-cost biomarker with an important pathophysiological background. The study by Jackson et al. from the MAGGIC individual patient meta-analysis investigated the prognostic importance of brachial PP in patients with heart failure and reduced (< 50%) ejection fraction (HF-REF) vs. preserved ejection fraction (HF-PEF).7 The strong point of this study results from the analysis of individual patient data from 22 studies with an impressive number of 27 046 patients included even though only 18.5% of them had HF-PEF. The authors reported that lower PP independently predicted all-cause mortality in HF-REF patients, confirming previous knowledge on the prognostic value of low PP in patients with HF-REF (probably an index of low stroke volume in these patients).1,2 In contrast, in HF-PEF patients, the importance of high PP (probably an index of increased arterial stiffness in these patients) is doubted, in contrast to what might have been expected on the basis of pathophysiology and …