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Ambulatory pulse pressure as predictor of outcome in older patients with systolic hypertension
We enrolled 808 older patients with isolated systolic hypertension (160 to 219/71
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| Published in: | American journal of hypertension 2002-10, Vol.15 (10), p.835-843 |
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| Main Authors: | , , , , , , , , , , , |
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| container_end_page | 843 |
| container_issue | 10 |
| container_start_page | 835 |
| container_title | American journal of hypertension |
| container_volume | 15 |
| creator | Staessen, Jan A. Thijs, Lutgarde O'Brien, Eoin T. Bulpitt, Christopher J. de Leeuw, Peter W. Fagard, Robert H. Nachev, Choudomir Palatini, Paolo Parati, Gianfranco Tuomilehto, Jaakko Webster, John Safar, Michel E. |
| description | We enrolled 808 older patients with isolated systolic hypertension (160 to 219/71 |
| doi_str_mv | 10.1016/S0895-7061(02)02987-4 |
| format | article |
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The patients (≥60 years) were randomized to nitrendipine (10 to 40 mg/day) with the possible addition of enalapril (5 to 20 mg/day) or hydrochlorothiazide (12.5 to 25 mg/day) or to matching placebos. At baseline, pulse pressure and mean pressure were determined from six conventional blood pressure (BP) readings and from 24-h ambulatory recordings. With adjustment for significant covariables, we computed mutually adjusted relative hazard rates associated with 10 mm Hg increases in pulse pressure or mean pressure. In the placebo group, the 24-h and nighttime pulse pressures consistently predicted total and cardiovascular mortality, all cardiovascular events, stroke, and cardiac events. Daytime pulse pressure predicted cardiovascular mortality, all cardiovascular end points, and stroke. The hazard rates for 10 mm Hg increases in pulse pressure ranged from 1.25 to 1.68. Conventionally measured pulse pressure predicted only cardiovascular mortality with a hazard rate of 1.35. In the active treatment group compared with the placebo patients, the relation between outcome and ambulatory pulse pressure was attenuated to a nonsignificant level. Mean pressure determined from ambulatory or conventional BP measurements was not associated with poorer prognosis. In conclusion, in older patients with isolated systolic hypertension higher pulse pressure estimated by 24-h ambulatory monitoring was a better predictor of adverse outcomes than conventional pulse pressure, whereas conventional and ambulatory mean pressures were not correlated with a worse outcome.</description><identifier>ISSN: 0895-7061</identifier><identifier>EISSN: 1941-7225</identifier><identifier>EISSN: 1879-1905</identifier><identifier>DOI: 10.1016/S0895-7061(02)02987-4</identifier><identifier>PMID: 12372669</identifier><identifier>CODEN: AJHYE6</identifier><language>eng</language><publisher>New York, NY: Oxford University Press</publisher><subject>Aged ; Ambulatory blood pressure monitoring ; Antihypertensive Agents - therapeutic use ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Cardiology. Vascular system ; Circadian Rhythm ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Double-Blind Method ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; hypertension ; Hypertension - diagnosis ; Hypertension - drug therapy ; Hypertension - mortality ; Male ; mean pressure ; Medical sciences ; Middle Aged ; Morbidity ; mortality ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; pulse pressure ; Risk Factors</subject><ispartof>American journal of hypertension, 2002-10, Vol.15 (10), p.835-843</ispartof><rights>American Journal of Hypertension, Ltd. © 2002 by the American Journal of Hypertension, Ltd. 2002</rights><rights>2002 INIST-CNRS</rights><rights>Copyright Nature Publishing Group Oct 2002</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13953682$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12372669$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Staessen, Jan A.</creatorcontrib><creatorcontrib>Thijs, Lutgarde</creatorcontrib><creatorcontrib>O'Brien, Eoin T.</creatorcontrib><creatorcontrib>Bulpitt, Christopher J.</creatorcontrib><creatorcontrib>de Leeuw, Peter W.</creatorcontrib><creatorcontrib>Fagard, Robert H.</creatorcontrib><creatorcontrib>Nachev, Choudomir</creatorcontrib><creatorcontrib>Palatini, Paolo</creatorcontrib><creatorcontrib>Parati, Gianfranco</creatorcontrib><creatorcontrib>Tuomilehto, Jaakko</creatorcontrib><creatorcontrib>Webster, John</creatorcontrib><creatorcontrib>Safar, Michel E.</creatorcontrib><creatorcontrib>Syst-Eur Trial Investigators</creatorcontrib><title>Ambulatory pulse pressure as predictor of outcome in older patients with systolic hypertension</title><title>American journal of hypertension</title><addtitle>AJH</addtitle><description>We enrolled 808 older patients with isolated systolic hypertension (160 to 219/71 <95 mm Hg) to investigate whether ambulatory measurement of pulse pressure and mean pressure can refine risk stratification. The patients (≥60 years) were randomized to nitrendipine (10 to 40 mg/day) with the possible addition of enalapril (5 to 20 mg/day) or hydrochlorothiazide (12.5 to 25 mg/day) or to matching placebos. At baseline, pulse pressure and mean pressure were determined from six conventional blood pressure (BP) readings and from 24-h ambulatory recordings. With adjustment for significant covariables, we computed mutually adjusted relative hazard rates associated with 10 mm Hg increases in pulse pressure or mean pressure. In the placebo group, the 24-h and nighttime pulse pressures consistently predicted total and cardiovascular mortality, all cardiovascular events, stroke, and cardiac events. Daytime pulse pressure predicted cardiovascular mortality, all cardiovascular end points, and stroke. The hazard rates for 10 mm Hg increases in pulse pressure ranged from 1.25 to 1.68. Conventionally measured pulse pressure predicted only cardiovascular mortality with a hazard rate of 1.35. In the active treatment group compared with the placebo patients, the relation between outcome and ambulatory pulse pressure was attenuated to a nonsignificant level. Mean pressure determined from ambulatory or conventional BP measurements was not associated with poorer prognosis. In conclusion, in older patients with isolated systolic hypertension higher pulse pressure estimated by 24-h ambulatory monitoring was a better predictor of adverse outcomes than conventional pulse pressure, whereas conventional and ambulatory mean pressures were not correlated with a worse outcome.</description><subject>Aged</subject><subject>Ambulatory blood pressure monitoring</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Pressure</subject><subject>Blood Pressure Monitoring, Ambulatory</subject><subject>Cardiology. Vascular system</subject><subject>Circadian Rhythm</subject><subject>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</subject><subject>Double-Blind Method</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>hypertension</subject><subject>Hypertension - diagnosis</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - mortality</subject><subject>Male</subject><subject>mean pressure</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>mortality</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>pulse pressure</subject><subject>Risk Factors</subject><issn>0895-7061</issn><issn>1941-7225</issn><issn>1879-1905</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><recordid>eNpd0VGL1DAQB_AgireefgQlIIo-VCdJkzSPx6Gux4GgJ8o9GNI2YbO2TU1SdL-9WXa9BZ8SMr8ZwvwRekrgDQEi3n6BRvFKgiCvgL4GqhpZ1ffQiqiaVJJSfh-t7sgZepTSFgBqIchDdEYok1QItUI_LsZ2GUwOcYfnZUgWz9GmtESLTdrfe9-VIg4OhyV3YbTYTzgMvY14NtnbKSf82-cNTruUw-A7vNnNNmY7JR-mx-iBM2Xqk-N5jr6-f3dzua6uP334eHlxXXkmVK64AkNM10pXd23bg7GGE2VMeRbAuLPGKsXA9QKck7QlrKctSOrqpuudUewcvTzMnWP4tdiU9ehTZ4fBTDYsSUtKBKdQF_j8P7gNS5zK3zQBKrgoC9qPe3ZUSzvaXs_Rjybu9L-9FfDiCEzqzOCimTqfTo4pzkRDi4ODC8t8qoLeR6hPEWqg-hhhacGHlsnkEsNdl9luKAAlnBRSHYhP2f45ifhTC8kk1-vvt_rbVXNDb6_W-jP7C09bpzI</recordid><startdate>20021001</startdate><enddate>20021001</enddate><creator>Staessen, Jan A.</creator><creator>Thijs, Lutgarde</creator><creator>O'Brien, Eoin T.</creator><creator>Bulpitt, Christopher J.</creator><creator>de Leeuw, Peter W.</creator><creator>Fagard, Robert H.</creator><creator>Nachev, Choudomir</creator><creator>Palatini, Paolo</creator><creator>Parati, Gianfranco</creator><creator>Tuomilehto, Jaakko</creator><creator>Webster, John</creator><creator>Safar, Michel E.</creator><general>Oxford University Press</general><general>Elsevier Science</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20021001</creationdate><title>Ambulatory pulse pressure as predictor of outcome in older patients with systolic hypertension</title><author>Staessen, Jan A. ; Thijs, Lutgarde ; O'Brien, Eoin T. ; Bulpitt, Christopher J. ; de Leeuw, Peter W. ; Fagard, Robert H. ; Nachev, Choudomir ; Palatini, Paolo ; Parati, Gianfranco ; Tuomilehto, Jaakko ; Webster, John ; Safar, Michel E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-i369t-590a1acb7f4cbbd0aea519aa90a6035feae9930fd60ff72b13d2b072f48cdfa93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Aged</topic><topic>Ambulatory blood pressure monitoring</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Pressure</topic><topic>Blood Pressure Monitoring, Ambulatory</topic><topic>Cardiology. Vascular system</topic><topic>Circadian Rhythm</topic><topic>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</topic><topic>Double-Blind Method</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>hypertension</topic><topic>Hypertension - diagnosis</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - mortality</topic><topic>Male</topic><topic>mean pressure</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>mortality</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>pulse pressure</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Staessen, Jan A.</creatorcontrib><creatorcontrib>Thijs, Lutgarde</creatorcontrib><creatorcontrib>O'Brien, Eoin T.</creatorcontrib><creatorcontrib>Bulpitt, Christopher J.</creatorcontrib><creatorcontrib>de Leeuw, Peter W.</creatorcontrib><creatorcontrib>Fagard, Robert H.</creatorcontrib><creatorcontrib>Nachev, Choudomir</creatorcontrib><creatorcontrib>Palatini, Paolo</creatorcontrib><creatorcontrib>Parati, Gianfranco</creatorcontrib><creatorcontrib>Tuomilehto, Jaakko</creatorcontrib><creatorcontrib>Webster, John</creatorcontrib><creatorcontrib>Safar, Michel E.</creatorcontrib><creatorcontrib>Syst-Eur Trial Investigators</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of hypertension</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Staessen, Jan A.</au><au>Thijs, Lutgarde</au><au>O'Brien, Eoin T.</au><au>Bulpitt, Christopher J.</au><au>de Leeuw, Peter W.</au><au>Fagard, Robert H.</au><au>Nachev, Choudomir</au><au>Palatini, Paolo</au><au>Parati, Gianfranco</au><au>Tuomilehto, Jaakko</au><au>Webster, John</au><au>Safar, Michel E.</au><aucorp>Syst-Eur Trial Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ambulatory pulse pressure as predictor of outcome in older patients with systolic hypertension</atitle><jtitle>American journal of hypertension</jtitle><addtitle>AJH</addtitle><date>2002-10-01</date><risdate>2002</risdate><volume>15</volume><issue>10</issue><spage>835</spage><epage>843</epage><pages>835-843</pages><issn>0895-7061</issn><eissn>1941-7225</eissn><eissn>1879-1905</eissn><coden>AJHYE6</coden><abstract>We enrolled 808 older patients with isolated systolic hypertension (160 to 219/71 <95 mm Hg) to investigate whether ambulatory measurement of pulse pressure and mean pressure can refine risk stratification. The patients (≥60 years) were randomized to nitrendipine (10 to 40 mg/day) with the possible addition of enalapril (5 to 20 mg/day) or hydrochlorothiazide (12.5 to 25 mg/day) or to matching placebos. At baseline, pulse pressure and mean pressure were determined from six conventional blood pressure (BP) readings and from 24-h ambulatory recordings. With adjustment for significant covariables, we computed mutually adjusted relative hazard rates associated with 10 mm Hg increases in pulse pressure or mean pressure. In the placebo group, the 24-h and nighttime pulse pressures consistently predicted total and cardiovascular mortality, all cardiovascular events, stroke, and cardiac events. Daytime pulse pressure predicted cardiovascular mortality, all cardiovascular end points, and stroke. The hazard rates for 10 mm Hg increases in pulse pressure ranged from 1.25 to 1.68. Conventionally measured pulse pressure predicted only cardiovascular mortality with a hazard rate of 1.35. In the active treatment group compared with the placebo patients, the relation between outcome and ambulatory pulse pressure was attenuated to a nonsignificant level. Mean pressure determined from ambulatory or conventional BP measurements was not associated with poorer prognosis. In conclusion, in older patients with isolated systolic hypertension higher pulse pressure estimated by 24-h ambulatory monitoring was a better predictor of adverse outcomes than conventional pulse pressure, whereas conventional and ambulatory mean pressures were not correlated with a worse outcome.</abstract><cop>New York, NY</cop><pub>Oxford University Press</pub><pmid>12372669</pmid><doi>10.1016/S0895-7061(02)02987-4</doi><tpages>9</tpages></addata></record> |
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| identifier | ISSN: 0895-7061 |
| ispartof | American journal of hypertension, 2002-10, Vol.15 (10), p.835-843 |
| issn | 0895-7061 1941-7225 1879-1905 |
| language | eng |
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| source | Oxford Journals Online |
| subjects | Aged Ambulatory blood pressure monitoring Antihypertensive Agents - therapeutic use Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Blood Pressure Blood Pressure Monitoring, Ambulatory Cardiology. Vascular system Circadian Rhythm Clinical manifestations. Epidemiology. Investigative techniques. Etiology Double-Blind Method Electrocardiography Female Follow-Up Studies Humans hypertension Hypertension - diagnosis Hypertension - drug therapy Hypertension - mortality Male mean pressure Medical sciences Middle Aged Morbidity mortality Predictive Value of Tests Prognosis Proportional Hazards Models pulse pressure Risk Factors |
| title | Ambulatory pulse pressure as predictor of outcome in older patients with systolic hypertension |
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