An outcome-driven threshold for pulse pressure amplification
: Huang, Qi-Fang; An, De-Wei; Aparicio, Lucas S.; Cheng, Yi-Bang; Wei, Fang-Fei; Yu, Yu-Ling; Sheng, Chang-Sheng; Yang, Wen-Yi; Niiranen, Teemu J.; Boggia, José; Stolarz-Skrzypek, Katarzyna; Tikhonoff, Valérie; Gilis-Malinowska, Natasza; Wojciechowska, Wiktoria; Casiglia, Edoardo; Narkiewicz, Krzysztof; Filipovský, Jan; Kawecka-Jaszcz, Kalina; Nawrot, Tim S.; Wang, Ji-Guang; Li, Yan; Staessen, Jan A.; International Database of Central Arterial Properties for Risk Stratification (IDCARS) Investigators
Publisher: Springer Nature
: 2024
: Hypertension Research
: Hypertension research : official journal of the Japanese Society of Hypertension
: Hypertens Res
: 47
: 2478
: 2488
: 0916-9636
: 1348-4214
DOI: https://doi.org/10.1038/s41440-024-01779-4
: https://www.nature.com/articles/s41440-024-01779-4
: https://research.utu.fi/converis/portal/detail/Publication/457303533
Pulse pressure amplification (PPA) is the brachial-to-aortic pulse pressure ratio and decreases with age and cardiovascular risk factors. This individual-participant meta-analysis of population studies aimed to define an outcome-driven threshold for PPA. Incidence rates and standardized multivariable-adjusted hazard ratios (HRs) of cardiovascular and coronary endpoints associated with PPA, as assessed by the SphygmoCor software, were evaluated in the International Database of Central Arterial Properties for Risk Stratification (n = 5608). Model refinement was assessed by the integrated discrimination (IDI) and net reclassification (NRI) improvement. Age ranged from 30 to 96 years (median 53.6). Over 4.1 years (median), 255 and 109 participants experienced a cardiovascular or coronary endpoint. In a randomly defined discovery subset of 3945 individuals, the rounded risk-carrying PPA thresholds converged at 1.3. The HRs for cardiovascular and coronary endpoints contrasting PPA < 1.3 vs ≥1.3 were 1.54 (95% confidence interval [CI]: 1.00-2.36) and 2.45 (CI: 1.20-5.01), respectively. Models were well calibrated, findings were replicated in the remaining 1663 individuals analyzed as test dataset, and NRI was significant for both endpoints. The HRs associating cardiovascular and coronary endpoints per PPA threshold in individuals <60 vs ≥60 years were 3.86 vs 1.19 and 6.21 vs 1.77, respectively. The proportion of high-risk women (PPA < 1.3) was higher at younger age (<60 vs ≥60 years: 67.7% vs 61.5%; P < 0.001). In conclusion, over and beyond common risk factors, a brachial-to-central PP ratio of <1.3 is a forerunner of cardiovascular coronary complications and is an underestimated risk factor in women aged 30-60 years. Our study supports pulse wave analysis for risk stratification.
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Argentina: The Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Belgium: European Union (HEALTH-F7-305507 HOMAGE), European Research Council (Advanced Researcher Grant 2011-294713-EPLORE and Proof-of-Concept Grant 713601-uPROPHET), European Research Area Net for Cardiovascular Diseases (JTC2017-046-PROACT) and Research Foundation Flanders, Ministry of the Flemish Community, Brussels, Belgium (G.0881.13); Belgium (APPREMED): The Research Institute Alliance for the Promotion of Preventive Medicine (URL: www.appremed.org) received a non-binding grant from OMRON Healthcare Co., Ltd., Kyoto, Japan; China: The National Natural Science Foundation of China (Grants 82270469, 82070432, 81970353), the Ministry of Science and Technology (2022YFC3601302), Beijing, China, and by the Shanghai Commissions of Science and Technology (Grants 19ZR1443300), and the Shanghai Municipal Health Commission (202340035, 20234Y0036, 201940297 and a Grant for Leading Academics 2022LJ022); Czech Republic: European Union (Grants LSHM-CT-2006–037093 and HEALTH-F4-2007–201550) and Charles University Research Fund (Project P36); Finland: Academy of Finland (Grant 321351), Emil Aaltonen Foundation, the Paavo Nurmi Foundation, the Urmas Pekkala Foundation, and the Hospital District of South-Western Finland; Italy: European Union (Grants LSHM-CT-2006–037093 and HEALTH-F4-2007–201550); Poland (Gdańsk): European Union (Grants LSHM-CT-2006–037093 and HEALTH-F4-2007–201550); Poland (Kraków): European Union (Grants LSHM-CT-2006–037093 and HEALTH-F4-2007–201550) and Foundation for Polish Science; Uruguay: Asociación Española Primera en Salud. Switzerland: Swiss National Science Foundation (FN 33CM30‐124087 and FN 33CM30‐140331). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
