Stroke volume pulse pressure ratio and cardiovascular risk in arterial hypertension

Ratio of stroke volume (SV, M-mode echocardiography) to pulse pressure (PP has been proposed as an estimate of total arterial compliance and has been shown to be related to body size, age, and heart rate in normal adults. SV/ PP was estimated in 294 hypertensive patients (98 women) as a raw value by use of SV/body surface area (SVi) and by the ratio of SV/PP to the value pr edicted by a previously developed equation (%SV/PP). At baseline, the 50 pa tients who had cardiovascular events over the following 10 years exhibited higher PP and lower SV/PP, SVi/PP, and %SV/PP (all P<0.008) than patients w ithout events. Crude risk of follow-up total and fatal cardiovascular event s increased with increasing level of PP find decreasing SV/PP, SVi/PP, and %SV/PP tall P<0.002). In multivariate logistic regression models with conti nuous covariates, the risk of total cardiovascular events was independently related to increasing age (P<0.0001) and left ventricular (LV) mass index (P<0.003) and decreasing values of %SV/PP (P<0.006) but not to increasing s ystolic, pulse, or mean blood pressure or gender. Similar although less str ong results were obtained with the use of SVi/PP (P<0.02), whereas SV/PP di d not enter the model as an independent predictor. Risk of cardiovascular d eath was only predicted by age and LV mass index. The %SV/PP was also an in dependent predictor of total cardiovascular events in Cox proportional haza rds analysis (exp[b]: 2.49, P<0.001) independent of age (exp[b]: 1.05, P<0. 003) and LV mass index (exp[b]: 1.02, P<0.0003), whereas no effect was dete cted for height. Thus, in patients with arterial hypertension, a reduced ra tio of M-mode echocardiographic SV/PP as a percentage of the value predicte d by demographic variables is a predictor of cardiovascular morbid events i ndependent of age and LV mass index.