Combined effects of heart rate and pulse pressure on cardiovascular mortality according to age

Objectives The aim of the study was to assess the combined effects of pulse pressure (PP) and heart rate (HR) on cardiovascular mortality in a large F rench population, Design The study population was composed of 125 513 men a nd 96 301 women aged 16-95 years who had a health check-up at the IPC Cente r between January 1978 and December 1988. Subjects taking antihypertensive treatment were excluded, Mortality was assessed for an 8-year period. HR an d PP were classified into three groups. HR groups were: < 60, 60-79 and <gr eater than or equal to> 80 beats per minute (bpm), PP groups were: < 58, 50 -64 and <greater than or equal to> 65 mmHg, Results In men, PP and HR were both positively associated with cardiovascular mortality risk, In women, me an arterial pressure (MAP) but not PP or HR was associated with cardiovascu lar mortality. In men, a combined elevation of PP and HR was associated wit h an important increase of cardiovascular mortality risk, The group with th e highest PP and the highest HR had a 4.8-fold increase in cardiovascular m ortality risk as compared to the reference group (PP < 50 mmHg and HR < 60 bpm), This effect was more pronounced in younger men (5.4-fold increase) th an in older men (3.7-fold increase), as compared to the reference groups of the same age. In Conclusion A combined elevation of the two components of pulsatile arterial stress is associated with an important increase in cardi ovascular mortality in men, especially in younger men. In women, steady-sta te stress (evaluated primarily by MAP), but not pulsatile stress, is an imp ortant determinant of cardiovascular mortality. J Hypertens 19:863-869 (C) 2001 Lippincott Williams & Wilkins.