Isolated systolic hypertension - Prognostic information provided by pulse pressure

Increased arterial stiffness results in increased characteristic impedance of the aorta and increased pulse wave velocity, which increases systolic an d pulse pressures, An association between increased pulse pressure and adve rse cardiovascular events has been found in normotensive and hypertensive p atient populations. Increased pulse pressure has also been associated with thickening of the carotid intima and media. However, the relationship betwe en pulse pressure and stroke has not previously been evaluated. In this stu dy, we examined the hypothesis that pulse pressure is an independent predic tor of stroke in elderly patients with systolic hypertension entered in the Systolic Hypertension in the Elderly Program. Differences in baseline char acteristics were examined by tertiles of pulse pressure. The independent pr ognostic value of pulse pressure and mean arterial pressure for predicting either stroke or total mortality was assessed with Cox proportional hazards models that included pulse pressure, mean arterial pressure, and other var iables that were significant on univariate analysis. This analysis demonstr ated an 11% increase in stroke risk and a 16% increase in risk of all-cause mortality for each 10-mm Hg increase in pulse pressure. Each IO-mm Hg incr ease in mean arterial pressure was independently associated with a 20% incr ease in the risk of stroke and a 14% increase in the risk of all-cause mort ality. These data provide strong evidence of an association of increased co nduit vessel stiffness, as indicated by increased pulse pressure, with stro ke and total mortality, independent of the effects of mean arterial pressur e, in elderly patients with isolated systolic hypertension.