Role Of Pulse Pressure Research Articles

Exploring the relationship between admission pulse pressure and clinical features in patients with spontaneous supratentorial intracerebral hemorrhage.

Elevated pulse pressure is commonly observed in cardiovascular diseases and serves as an independent risk factor and predictor of cardiac mortality. However, the role of pulse pressure in patients with spontaneous intracerebral hemorrhage (ICH) remains uncertain. This study aimed to investigate the association between admission pulse pressure and clinical characteristics, including in-hospital outcomes, in ICH patients. We retrospectively analyzed the data of 292 ICH patients, categorizing them into two groups based on admission wide pulse pressure: > 100mmHg (n = 60) and ≤ 100mmHg (n = 232). Clinical characteristics and in-hospital outcomes were compared between the groups, and multivariate logistic regression was performed to identify independent factors. Patients with wide pulse pressure were older, had lower Glasgow Coma Scale, larger intraparenchymal hematomas, more pronounced midline shifts, and higher rates of intraventricular hematoma extension and hydrocephalus. These patients also experienced higher frequencies of craniotomy or craniectomy and longer hospital stays. Multivariate logistic regression revealed that pulse pressure > 100mmHg was significantly associated with increased in-hospital mortality (odds ratio 4.31, 95% confidence interval 1.12-16.62, p = 0.03), but not with a modified Rankin Scale score of 4-6. In conclusion, our investigation demonstrates a significant relationship between admission pulse pressure and severe clinical characteristics in ICH patients. Importantly, a wider pulse pressure is linked to heightened in-hospital mortality. These results underscore the necessity for customized strategies to predict patient outcomes in this population. Further research is essential to explore potential therapeutic interventions targeting pulse pressure to improve clinical outcomes for ICH patients.

Pulse pressure and adverse perinatal outcomes in patients with mild chronic hypertension during pregnancy

Pulse pressure (PP) – the difference between systolic and diastolic blood pressure (BP) – is significantly associated with cardiovascular events including death. However, the relationship between PP and pregnancy outcomes is unknown. We evaluated the association between PP and maternal and perinatal outcomes in women with mild chronic hypertension (cHTN). Secondary analysis of The CHAP Trial – an open-label randomized controlled trial of antihypertensives (vs. none) for mild cHTN (BP< 160/105 mmHg). Participants without PP information or outcomes were excluded. Visit count and average PP per patient in active treatment and control groups were compared. The primary analysis evaluated the association between PP during post-randomization clinic visits (5mmHg increments), CHAP primary composite outcome, and small for gestational age (SGA). Logistic regression models were adjusted for randomization assignment. Of 2,325 eligible participants, 50.3% (n=1170) were randomized to active treatment and 49.7% (n=1155) to control. Participants in the active group had marginally more BP assessments per patient (7.4 ± 3.0 vs 7.1 ± 2.9, p = 0.02). Average PP per patient was lower in the active compared to control group (49.9 ± 7.8 vs 50.6 ± 8.0, p=0.03) (Figure). Mean PP was positively associated with the composite outcome, severe preeclampsia and indicated preterm birth (PTB)< 35 weeks while active treatment was protective in the adjusted model (Table). Conversely, PP was negatively associated with SGA< 5th percentile but not SGA< 10th; active treatment was associated with neither. Mean PP was lower in pregnant participants with mild CHTN who were randomized to active treatment. Higher mean PP was associated with the CHAP primary composite outcome, severe preeclampsia and indicated PTB< 35 weeks, but negatively associated with SGA < 5th. Given potential variation in the relationship between treatment of CHTN in pregnancy and SGA, the role of PP as a mediator should be investigated in future studies to reduce adverse HTN-related outcomes without increasing SGA.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Predictive power of 24-h ambulatory pulse pressure and its components.

Objective: The role of pulse pressure (PP) ‘widening’ at older and younger age as a cardiovascular risk factor is still controversial. Mean PP, as determined from repeated blood pressure (BP) readings, can be expressed as a sum of two components: ‘elastic PP’ (elPP) and ‘stiffening PP’ (stPP) associated, respectively, with stiffness at the diastole and its relative change during the systole. We investigated the association of 24-h ambulatory PP, elPP, and stPP (‘PP variables’) with mortality and composite cardiovascular events in different age classes. Method: Longitudinal population-based cohort study of adults with baseline observations that included 24-h ambulatory BP. Age classes were age 40 or less, 40-50, 50-60, 60-70, and over 70 years. Co-primary endpoints were total mortality and composite cardiovascular events. The relative risk expressed by hazard ratio per 1SD increase for each of the PP variables was calculated from multivariable-adjusted Cox regression models. Results: The 11,848 participants from 13 cohorts (age 53±16 years, 50% men) were followed for up for 13.7±6.7 years. A total of 2,946 participants died (18.1 per 1000 person-years) and 2093 experienced a fatal or nonfatal cardiovascular event (12.9 per 1000 person-years). Mean PP, elPP, and stPP were, respectively, 49.7, 43.5, and 6.2 mmHg, and elPP and stPP were uncorrelated (r = -0.07). At age 50-60 years, all PP variables displayed association with risk for almost all outcomes. From age over 60 years to age over 70 years, hazard ratios of PP and elPP were similar and decreased gradually but differently for pulse rate lower than or higher than 70 bpm, whereas stPP lacked predictive power in most cases. For age 40 years or less, elPP showed protective power for coronary events, whereas stPP and PP predicted stroke events. Adjusted and unadjusted hazard ratio variations were similar over the entire age range. Conclusion: This study provides a new basis for associating PP components with outcome and arterial properties in different age groups and at different pulse rates for both old and young age. The similarity between adjusted and unadjusted hazard ratios supports the clinical usefulness of PP components but further studies are needed to assess the prognostic significance of the PP components, especially at the young age.

Predictive power of 24-h ambulatory pulse pressure and its components for mortality and cardiovascular outcomes in 11 848 participants recruited from 13 populations.

The role of pulse pressure (PP) 'widening' at older and younger age as a cardiovascular risk factor is still controversial. Mean PP, as determined from repeated blood pressure (BP) readings, can be expressed as a sum of two components: 'elastic PP' (elPP) and 'stiffening PP' (stPP) associated, respectively, with stiffness at the diastole and its relative change during the systole. We investigated the association of 24-h ambulatory PP, elPP, and stPP ('PP variables') with mortality and composite cardiovascular events in different age classes. Longitudinal population-based cohort study of adults with baseline observations that included 24-h ambulatory BP. Age classes were age 40 or less, 40-50, 50-60, 60-70, and over 70 years. Co-primary endpoints were total mortality and composite cardiovascular events. The relative risk expressed by hazard ratio per 1SD increase for each of the PP variables was calculated from multivariable-adjusted Cox regression models. The 11 848 participants from 13 cohorts (age 53 ± 16 years, 50% men) were followed for up for 13.7 ± 6.7 years. A total of 2946 participants died (18.1 per 1000 person-years) and 2093 experienced a fatal or nonfatal cardiovascular event (12.9 per 1000 person-years). Mean PP, elPP, and stPP were, respectively, 49.7, 43.5, and 6.2 mmHg, and elPP and stPP were uncorrelated ( r = -0.07). At age 50-60 years, all PP variables displayed association with risk for almost all outcomes. From age over 60 years to age over 70 years, hazard ratios of of PP and elPP were similar and decreased gradually but differently for pulse rate lower than or higher than 70 bpm, whereas stPP lacked predictive power in most cases. For age 40 years or less, elPP showed protective power for coronary events, whereas stPP and PP predicted stroke events. Adjusted and unadjusted hazard ratio variations were similar over the entire age range. This study provides a new basis for associating PP components with outcome and arterial properties in different age groups and at different pulse rates for both old and young age. The similarity between adjusted and unadjusted hazard ratios supports the clinical usefulness of PP components but further studies are needed to assess the prognostic significance of the PP components, especially at the young age.

PREDICTIVE POWER OF 24-HOUR AMBULATORY PULSE PRESSURE AND ITS COMPONENTS FOR MORTALITY AND CARDIOVASCULAR OUTCOMES IN 11,848 PARTICIPANTS RECRUITED FROM 13 POPULATIONS

Objective: The role of pulse pressure ’widening’ at older age, as a cardiovascular risk factor is still controversial. 24-hour ambulatory pulse pressure (PP) was previously expressed as a sum of two components: ’elastic’ PP (elPP) and 'stiffening’ PP (stPP) associated, respectively, with arterial stiffness at diastole and the change in stiffness during systole. We investigated the association of PP, elPP and stPP (’PP variables’) with mortality and composite cardiovascular (CV) events in different age classes. Design and method: Longitudinal population-based cohort study of adults from Europe, Asia, and South America with baseline observations, including 24-hour ambulatory BP. Age classes were age &lt; 50, 50–60, 60–70, and &gt; 70 year. Co-primary endpoints were total mortality and composite CV events. Hazard ratios (HRs) per 1-SD increase in the PP variables were calculated from multivariable adjusted Cox regression models. Results: The 11,848 participants from 13 cohorts (age 53 ± 16, 50% males) were followed up for 13.4 ± 6.9 years. A total of 2946 participants died (18.1 per 1000 person-years) and 2093 experienced a fatal or non-fatal cardiovascular event (12.9 per 1000 person-years). PP components were uncorrelated (r = -0.07), and the ratio stPP/elPP was 0.143. PP and elPP showed a curvilinear relationship with age reaching a nadir around middle-age, whereas stPP steadily increased from age 30 years onwards. In persons ?50 years of age, but not in those &lt; 50 years, both PP and elPP were associated with increased risk for the primary endpoints. For total mortality and cardiovascular events hazard ratios for PP decreased from 50–60 years old participants to those aged &gt; 70 years (P &lt; 0.02); from 1.29[95%CI: 1.13–1.46] to 1.11[1.05–1.15], and from 1.40[1.24–1.58] to 1.16[1.10–1.23], respectively, and for elPP for cardiovascular events; from 1.29[1.14–1.45] to 1.16[1.09–1.23]. On the other hand, stPP was associated with increased risk for the primary endpoints in subjects 50 to 60 years of age but not in the older age groups. Conclusions: The age-related increase in PP variables is not reflected in a corresponding PP-associated increase in cardiovascular risk. Results support the view that normal ageing weakens the association of PP variables with CV risk.

The role of pulse pressure in navigating the paradigm of chronic kidney disease progression in type 2 diabetes mellitus.

Arterial stiffness is a risk factor for chronic kidney disease progression (CKD). Pulse pressure is a surrogate marker of arterial stiffness. It is unclear if pulse pressure predicts CKD progression in type 2 diabetes mellitus. This was prospective study involving 1494 patients with estimated glomerular filtration rate (eGFR) ≥ 15ml/min/1.73 m2. Carotid-femoral pulse wave velocity was measured using applanation tonometry. Pulse pressure was calculated as difference between systolic and diastolic blood pressures. CKD progression was defined as worsening of eGFR categories (stage 1, ≥ 90ml/min/1.73m2; stage 2, 60-89ml/min/1.73m2; stage 3a, 45-59ml/min/1.73m2; stage 3b, 30-44ml/min/1.73m2; stage 4; 15-29ml/min/1.73m2; and stage 5, < 15ml/min/1.73m2) with ≥ 25% decrease in eGFR from baseline. After follow-up of up to 6years, CKD progression occurred in 33.5% of subjects. Subjects in 2nd, 3rd and 4th quartiles of peripheral pulse pressure experienced higher risk of CKD progression with unadjusted hazard ratios (HRs) 1.55 [95% confidence interval (CI) 1.13-2.11; p = 0.006], 2.58 (1.93-3.45; p < 0.001) and 3.41 (2.58-4.52; p < 0.001). In the fully adjusted model, the association for 2nd, 3rd and 4th quartiles remained with HRs 1.40 (1.02-1.93; p = 0.038), 1.87 (1.37-2.56; p < 0.001) and 1.75 (1.25-2.44; p = 0.001) respectively. Similarly, 2nd, 3rd and 4th quartiles of aortic pulse pressure were associated with higher hazards of CKD progression with HRs 1.73 (1.25-2.40; p = 0.001), 1.65 (1.18-2.29; p = 0.003) and 1.81 (1.26-2.60; p = 0.001). Increasing urinary albumin-to-creatinine ratio accounted for 44.0% of the association between peripheral pulse pressure and CKD progression. Individuals with high pulse pressure were more susceptible to deterioration of renal function. Pulse pressure could potentially be incorporated in clinical practice as an inexpensive and readily available biomarker of renal decline in type 2 diabetes mellitus. Graphic abstract.

Pulse Pressure Affects Efficacy of Body Mass Index in Promoting the Onset of Diabetes: A Population-Based Cohort Study

Background: The role of pulse pressure and body mass index effect modifiers on the risk of onset of diabetes is unknown. Objectives: This study examined whether higher pulse pressure(PP) and higher body mass index (BMI)jointly increase the risk of onset of diabetes, and, if so, whether exercise for weight is particularly effective in diabetes prevention in such a setting. Methods: This is a retrospective cohort study using healthy screening programme data. A total of 211810 adult Chinese persons>20 years old across 32 sites and 11 cities in China(Shanghai, Beijing, Nanjing, Suzhou, Shenzhen, Changzhou, Chengdu, Guangzhou, Hefei, Wuhan, Nantong)were selected for the study, these persons were free of diabetes at baseline. All of the data were extracted from a computerised database established by the Rich Healthcare Group in China. Fasting plasma glucose levels were measured and information regarding the history of diabetes was collected at each visit. Diabetes was diagnosed as fasting plasma glucose≥7.00 mmol/L and/or self-reported diabetes. Patients were censored at the date of diagnosis or the final visit, whichever came first. The primary endpoint was the onset of diabetes. To explore association of BMI and PP with increased risk of incident diabetes, multivariate Cox's regression was performed. We also explored a priori interaction between BMI and PP using the Cox regression model, and performed subgroup analyses to further assess whether the relationship between BMI and incident diabetes varied by PP subgroups. It was noted that the entire study was completed by Rich Healthcare Group, and uploaded the data to the DATADRYAD website by Ying Chen et al. The author only used this data for secondary analysis. Results: With a median follow-up of 3.1 years, 4173 of the 211810 participants developed diabetes. The risk of incident diabetes increased proportionally with increasing baseline BMI values, with a 12.5% increased risk of incident diabetes with each kg/m2 increase in BMI(95% CI 1.104 to 1.146). Samely, the risk of incident diabetes also increased proportionally with increasing baseline pulse pressure values, with a 0.5% increased risk of incident diabetes with each mmHg increase in pulse pressure(95% CI 1.001, 1.010). Across all PP subgroups, there was a linear association between BMI and the risk of incident diabetes, although there was a stronger association between BMI and incident diabetes in the PP<=20mmHg groups (PP x BMI interaction, p<0.05). Further, When compared to normal weight subjects with PP<=20mmHg, subjects with obesity and PP<=20mmHg had a nearly sevenfold increase in risk (HR 6.455 (0.584-71.346))of incident diabetes. Conclusions: The association of BMI with incident diabetes was likely to vary with pulse pressure status among adult Chinese persons. The subgroup with low PP and high BMI had the highest risk of incident diabetes. Funding Statement: This study was supported in part by the basic research project and technology development projects of Shenzhen Municipal Science and Technology Innovation Council accounts JCYJ20130329104904512, CXZZ20140421155346007, CXZZ20150601140615135, and JCYJ20180302145033769;this study was also supported in part by Discipline Construction Ability Enhancement Project of Shenzhen Municipal Health and Family Planning Commission(SZXJ2017031). Declaration of Interests: The authors state: None declared. Ethics Approval Statement: This study was approved by the Rich Healthcare Group Review Board, and the information was retrieved retrospectively.

A6808 The Role of Pulse Pressure in the Immediate Prognosis of Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention

A6808 The Role of Pulse Pressure in the Immediate Prognosis of Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention

Abstract P454: Does Intensive Pulse Pressure control results in lower rates of cardiovascular events? An Analysis of Systolic BP Intervention Trial (SPRINT) database

Introduction: A wide pulse pressure (PP) is a marker of increased artery stiffness and high cardiovascular risk. A high PP may reflect already diseased arterial walls, with several adverse cardiac implications of potential prognostic value. Previous studies show that arterial stiffness is itself an independent predictor of the risk of all-cause mortality, cardiovascular mortality, coronary events and stroke in hypertensive subjects. No guidelines exist regarding tight pulse pressure in chronic hypertension population. Method: For the purpose of our study, we examined SPRINT data collected between November 2010 and August 2015. The role of PP and DBP was studied as a qualitative parameter with separation according to the 4 quartiles defined in the studied population. We then combined the results of both PP and DBP in conjunction with preexistence intensive vs. control arm for further analysis. Results: Our secondary analysis of SPRINT data first confirmed NEJM article that intensive SBP control reduced rates of heart failure (HF), CVD death, Death from any cause, and SPRINT primary outcome or death. There was a significant difference in primary outcome in each PP quartile. Higher PP quartiles were more likely to have higher rate of MI, stroke, HF, CVD death, and SPRINT primary outcome or death. There also a significant increase in SPRINT primary outcome and Heart Failure when DBP &lt;70 in the intensive treatment arm. Finally, SPRINT data has confirmed that participants in PP 1 and PP 2 with DBP &gt; 70 have significant lower rate of SPRINT primary outcome and death compared to other group regardless of treatment arm. Conclusion: In the SPRINT database of 9347 participants, we found that higher PP conferred an increased risk for multiple adverse cardiovascular event. Our study is among the largest US studies of PP and adds further support to the prognostic utility of PP. In addition, the SPRINT database offers a contemporary analysis of the relationship between PP and DBP, which is important given that nature pathophysiology of blood pressure. Current study also strengthen the possibility that DBP &lt;70 mm Hg was associated with a higher rate of cardiac events.

Office Pulse Pressure Is a Predictor of Favorable Outcome in Young- to Middle-Aged Subjects With Stage 1 Hypertension.

The role of pulse pressure in young individuals remains controversial. The aim of the present study was to investigate the clinical significance of elevated pulse pressure in young- to middle-aged subjects screened for stage 1 hypertension. We examined 1241 subjects (mean age, 33.1±8.4 years) from the HARVEST (Hypertension Ambulatory Recording Venetia Study), during a median follow-up of 12.1 years. To evaluate the predictive value of pulse pressure and mean blood pressure for future hypertension needing treatment and for cardiovascular events, participants were grouped into pressure tertiles. Significant determinants of pulse pressure were male sex (P=0.029), younger age (P<0.001), physical activity (P=0.003), heart rate (P<0.001), systolic white coat effect (P<0.001), and stroke volume (n=829; P<0.001). During follow-up, 65.1% of participants developed hypertension requiring pharmacological treatment and 5.1% experienced a cardiovascular event. Participants in the highest pulse pressure tertile had a reduced risk of incident hypertension compared with those of the bottom tertile (hazard ratio, 0.75; 95% confidence interval, 0.62-0.91; P=0.003). In contrast, participants in the top mean blood pressure tertile had an increase in risk (1.91; 1.57-2.33; P<0.001). In addition, participants in the highest pulse pressure tertile had a reduced risk of cardiovascular events (0.35; 0.17-0.73; P=0.005) and those in the top mean blood pressure tertile had an increase in risk (3.06; 1.32-7.09; P=0.009). Our data show that in subjects <45 years, only mean blood pressure is a predictor of adverse outcome whereas high pulse pressure even carries a reduced risk.

Erratum to: Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation.

Erratum to: Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation.

Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation

The hemodynamic and geometric factors leading to propagation of acute Type B dissections are poorly understood. The objective is to elucidate whether geometric and hemodynamic parameters increase the predilection for aortic dissection propagation. A pulse duplicator set-up was used on porcine aorta with a single entry tear. Mean pressures of 100 and 180 mmHg were used, with pulse pressures ranging from 40 to 200 mmHg. The propagation for varying geometric conditions (%circumference of the entry tear: 15–65%, axial length: 0.5–3.2 cm) were tested for two flap thicknesses (1/3rd and 2/3rd of the thickness of vessel wall, respectively). To assess the effect of pulse and mean pressure on flap dynamics, the %true lumen (TL) cross-sectional area of the entry tear were compared. The % circumference for propagation of thin flap (47 ± 1%) was not significantly different (p = 0.14) from thick flap (44 ± 2%). On the contrary, the axial length of propagation for thin flap (2.57 ± 0.15 cm) was significantly different (p < 0.05) from the thick flap (1.56 ± 0.10 cm). TL compression was observed during systolic phase. For a fixed geometry of entry tear (%circumference = 39 ± 2%; axial length = 1.43 ± 0.13 cm), mean pressure did not have significant (p = 0.84) effect on flap movement. Increase in pulse pressure resulted in a significant change (p = 0.02) in %TL area (52 ± 4%). The energy acting on the false lumen immediately before propagation was calculated as 75 ± 9 J/m2 and was fairly uniform across different specimens. Pulse pressure had a significant effect on the flap movement in contrast to mean pressure. Hence, mitigation of pulse pressure and restriction of flap movement may be beneficial in patients with type B acute dissections.

Future Treatment of Hypertension: Shifting the Focus from Blood Pressure Lowering to Arterial Stiffness Modulation?

Isolated systolic hypertension is the commonest form of hypertension from middle age onwards. Achieving target systolic blood pressure (BP) control remains difficult in everyday clinical practice and even under clinical trial conditions. Most antihypertensive medicines were designed to lower peripheral vascular resistance, which was considered the haemodynamic determinant of hypertension; most are effective in reducing steady but not pulsatile components of BP. Arterial stiffness, defined via aortic length-specific pulse wave velocity (PWV), is thought to be an important determinant of pulse pressure widening through its effects on the timing and amplitude of pressure wave reflection, and/or the aorta's Windkessel function, or its excess 'reservoir' pressure. Whereas pulse pressure is neither an independent nor consistent cardiovascular risk factor, particularly below the age of about 60 years, PWV has become the most powerful predictor of cardiovascular outcomes including mortality, independent of systolic, pulse, mean or other BP components. PWV is therefore a more direct target for treatment. This review addresses the potential therapeutic options for targeting arterial stiffness and the role of pulse pressure.

Role of Pulse Pressure in Worsening the Renal Function of Patient with Hypertension

Blood pressure (BP) is a periodic phenomenon consisting of two components: steady and pulsatile. Recent studies in the late 2000 suggest that Pulse Pressure (PP) is a strong predictor of cardiovascular end points, and is perhaps stronger than MAP, SBP and DBP.1 PP is important independent prognostic markers of cardiovascular morbidity and mortality.2 However still, the normal range of PP is not known. Chronic kidney disease (CKD) is a significant global problem creating an increasing worldwide health and economic burden. As CKD is usually silent until its late stages, many patients are detected only shortly before the onset of symptomatic kidney failure when there are few opportunities to prevent adverse outcomes.3 Proteinuria and albuminuria are the earliest markers of kidney damage in patients with diabetes, hypertension and glomerular diseases, and persistent increases in levels are the most common markers of kidney damage in adults.3 The CARI Early CKD Working Group prefers albuminuria because it accurately predicts renal and cardiovascular risks, exhibits greater sensitivity for detecting lower, clinically important proteinuria.3 The authors intend to conduct observational cross-sectional study regarding BP components in conjunction with early sign of worsening renal failure in all cardiac patients without previous history of renal disease and diabetes. There were 493 valid samples to be analyzed using SPSS-21 program. Bivariate Pearson Correlation in all samples yielded equivalent significant low positive correlation among those blood pressure components towards occurrence of microalbuminuria. Moreover, when samples with diabetes were excluded, only SBP and PP gave significant high positive correlation towards microalbuminuria (R = .721; p = .008 and R = .711; p = .010 respectively). Surprisingly, the very high positive correlation between PP and microalbuminuria has only proven significant in group with PP > 60 mmHg (R = .992; p = .008). In samples with normal BP, Spearman correlation revealed significant high negative correlation of DBP and MAP towards microalbuminuria when SBP and PP gave significant positive correlation towards proteinuria in other samples with hypertension. As final words, to the extent of the author knowledge, this is the first study in Indonesia that prove higher PP as independent risk of early sign of worsening renal failure, in all patients regardless of their blood pressure level. Pulse pressure more than 60 mmHg in non-diabetic samples was able to express its very high positive correlation towards incidence of microalbuminuria. DBP and MAP showed to be important towards microalbuminuria in normotensive group, as SBP and PP in hypertensive group. Hence, more study needed to get other evidences on the role of blood pressure component in worsens the renal function in order to get better management approach.

Prognostic Role of Pulse Pressure in the Acute Phase of Myocardial Infarction

Objective: Pulse pressure is a cardiovascular risk factor. The aim of our study was to assess the short and medium term prognosis of myocardial infarction in the African black having a high pulse pressure. Methods: We performed a comparative retrospective study of 200 patients hospitalized in the Cardiology Institute of Abidjan. The first group (100 patients) had a high pulse pressure (≥60 mmHg). The second (100 patients) had normal pulse pressure (≤60 mmHg). The primary outcome was mortality. Secondary endpoints were represented by hemodynamic complications, rhythmic and conduction disturbances. Both groups of patients were matched. The matching is performed by socio-demographic criteria, the seat of necrosis and cardiovascular risk factors. The authors explained the choice of 60 mmHg as references because in all their studies they have realized that it is from 60 mmHg pulse pressure morbid events that occur in prospective studies and retrospective studies in stiffness of the great arteries is responsible for all these events. Pulse pressure is in itself, an independent cardiovascular risk factor in systolic blood pressure, diastolic blood pressure when associated with myocardial infarction, it becomes from 60 mmHg poor prognostic factor especially in the acute phase. Results: The mean age was 54.46 ± 10.10 years for patients with normal pulse pressure and 52.32 ± 10.89 years in patients with high pulse pressure. Patients with elevated pulse pressure were twice as left ventricular failure (Chi2 = 3.71; P = 0.048 = 2 OR 95% CI = 0.93 to 4.29). These patients had an ejection fraction and fractional shortening double bass (Chi2 = 31.23 P = 0.00001, OR = 2.2 95% CI 0.8 to 17.4) 10 mmHg for increased pulse pressure we observed an average growth of 18% mortality rate. Mortality was three times higher in patients with elevated pulse pressure (Khi2 = 15, 06 ddl = 1 P = 0.0001 OR = 3.34 95% CI 1.72 to 6.52). Conclusion: The high pulse pressure represented an independent poor prognostic factor in the acute phase of myocardial infarction in the black African.

Пульсовое давление крови: роль в гемодинамике и прикладные возможности в функциональной диагностике

Обоснована гемодинамическая роль пульсового давления крови как переходной функции нейрогуморальной регуляции и системообразующего элемента кровообращения. Этот факт cтал аргументом для использования пульсового давления крови в предложенном способе линейной регрессии параметров АД (КАСПАД — количественный анализ связей параметров АД в стратифицированном гемодинамическом пространстве). C помощью способа КАСПАД можно дать описание (аналитическое/графическое) индивидуального состояния гемодинамики в интервале времени наблюдения. По коэффициентам получаемой регрессии проводится функциональная диагностика типа гемодинамики согласно предложенной классификации и определяется давление в области затухающей пульсовой волны. Нормотензивные лица с патологическими типами по КАСПАД, указывающими на латентные гемодинамические нарушения, нуждаются в наблюдении и обследовании, а различие типов гемодинамики у пациентов с АГ требует дифференцированного лечения. Способ открывает новые перспективы для анализа происходящих в кровообращении процессов и может быть полезен в фундаментальных исследованиях гемодинамики сердечно-сосудистой системы, профилактической медицине, кардиологии.

New trends in the treatment of hypertension in 2013: the renaissance of pulse pressure

The article examines the published data on the prognostic value of a high pulse pressure. Given is the position of European experts on the role of pulse pressure as a marker of target lesions limited hypertension.The possibilities of antihypertensive therapy in reducing the pulse pressure are also discussed.

Новые тенденции в лечении артериальной гипертонии 2013 года: ренессанс пульсового АД

The article examines the published data on the prognostic value of a high pulse pressure. Given is the position of European experts on the role of pulse pressure as a marker of target lesions limited hypertension.The possibilities of antihypertensive therapy in reducing the pulse pressure are also discussed.

Ambulatory Pulse Pressure

See related article, p 229–237 Blood pressure (BP) traditionally has been measured in terms of peak (systolic) and trough (diastolic) values, with systolic BP being preferred compared with diastolic BP because of its stronger prognostic value for cardiovascular morbidity and mortality.1 However, a more physiologically appropriate view considers the BP waveform as being composed of a steady component (mean arterial pressure) on which cyclic oscillations, with amplitude represented by pulse pressure (PP), are superimposed. PP reflects large artery stiffness as well as several other cardiovascular parameters, including timing and magnitude of reflected waves, stroke volume, and rapidity of ventricular ejection. PP is a better predictor of cardiovascular complications compared with mean arterial pressure in elderly individuals.2 In the 2013 European Society of Hypertension/European Society of Cardiology guidelines, an office PP ≥60 mm Hg was included among the markers of asymptomatic organ damage to be used for cardiovascular risk stratification,3 although the above cutoff value does not seem to be supported by any specific reference. Despite a large body of literature, there is still controversy regarding the incremental value of PP as an independent cardiovascular risk factor. Also, PP measurement in the physician’s office may overestimate usual PP levels in the single individual, because office BP measurement is usually accompanied by a greater rise in systolic than in diastolic BP.4 Twenty-four-hour PP is considered a more accurate measure of an individual’s usual PP and a stronger predictor of cardiovascular risk,5 although its prognostic value has been examined in a relatively few studies with a limited number of events.5–9 In the current issue of Hypertension , Gu et al10 shed new light on the role of PP in cardiovascular risk stratification. A total of 9938 individuals aged between 18 and 93 years drawn from …

Characterization of Dust Particles Emitted Through Pulse-Jet Fabric Filters During Industrial Pollution Control

The present investigation elucidates the role of pulse-cleaning parameters and filter media designs on the extent of dust emission and emitted particle characteristics during industrial pollution control using the pulse-jet filtration process. The study is followed by statistical analysis based on L8 (27) orthogonal design methodology. The experimental study shows that the dust concentration in clean gas increases with an increase in pulse pressure and pulse duration, whereas it decreases with an increase in pulse cycle. However, the contribution of pulse pressure and pulse duration is much higher than the impact of pulse cycle. In regard to the impact of filter media design, a higher level of bag height (which also implies lower air-to-cloth ratio) and lower level of seamline spacing can lead to higher outlet emissions at the transitory stage. The role of pulse pressure, bag height, and seamline spacing are found to be very significant in regulating fine particles in the emission (PM2.5) and, consequently, the aforesaid factors affect all volume particles diameters (D10, D50, and D97) and weight mean particles diameter D (4, 3) of particles in bulk.