ELASTIC COMPONENT OF 24 -HOUR OF PULSE PRESSURES PREDICTS CARDIOVASCULAR AND TOTAL MORTALITY IN THE OHASAMA STUDY

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Objective: 24-hour ambulatory pulse pressure (PP) is a powerful predictor of outcome. We attempted to apply the recently described PP components, an elastic (elPP), and systolic stiffening (stPP) components from 24-hour ambulatory blood pressure (BP) monitoring (AMBP), and examine their influence on outcome in the Ohasama study populationDesign and method: Included were participants of the Ohasama study without history of cardiovascular disease (CVD), who were followed-up for total and CVD mortality, and for stroke morbidity. The PP components were derived from 24-hour systolic and diastolic BP using a model based on the nonlinear pressure-volume relationship in arteries that express pressure-stiffness relationship. Outcome predictive power, was estimated by Cox regression models hazard ratio (HR) with 95% confidence interval (CI), applied to elPP, and stPP, adjusted for age, gender, BMI, smoking, drinking, diabetes mellitus, total cholesterol, antihypertensive treatment, and mean arterial pressure (MAP). Results: Of 1745 participants (age 60.7 ± 11.6, 65% female), 580 died, 212 of CVD, and 290 experienced a stroke during 17 follow-up years. PP was strongly correlated with elPP (r = 0.89) and less so with stPP (r = 0.58), the correlation between the 2 components was weak (r = 0.15). After adjustment, PP (per 1 mmHg increment) HR of total and CVD mortality and stroke morbidity were, 1.01, 1.02, 1.0, 95%CI 1.00–1.03, 1.00–1.05, 0.98–1.02, respectively. Corresponding HRs and 95%CIs were nonsignificant for elPP, and stPP. However when stratified by pulse rate (PR) <=68.5 bpm (median, n = 872), total (327 deaths) and CVD (131 deaths) mortality were predicted by elPP (per 1 mmHg increment), HR 1.03 95%CI 1.01–1.05, and 1.040 95%CI 1.01–1.07 respectively. In the subgroup of treated participants with hypertension and PR<=68.5 bpm (n = 309), total (177 deaths) and CVD (77deaths) mortality were predicted by elPP, HR of 1.04 95%CI 1.02–1.07, and 1.05, 1.01–1.09 respectively. Stroke morbidity was not predicted by either PP or the PP components Conclusions: In a rural Japanese population elPP but not stPP, was predictive of total and CVD mortality even when adjusted for MAP and conventional risk factors in the subpopulation with slower pulse rate. This was mostly among the treated hypertensive patients.