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Pulse Pressure and Risk for Cardiovascular Events in Patients With Atherothrombosis: From the REACH Registry.

Publication ,  Journal Article
Selvaraj, S; Steg, PG; Elbez, Y; Sorbets, E; Feldman, LJ; Eagle, KA; Ohman, EM; Blacher, J; Bhatt, DL; REACH Registry Investigators,
Published in: J Am Coll Cardiol
February 2, 2016

BACKGROUND: Pulse pressure (PP) provides valuable prognostic information in specific populations, but few studies have assessed its value on cardiovascular outcomes in a broad, worldwide population. OBJECTIVES: The aim of this study was to determine whether PP is associated with major adverse cardiovascular outcomes, independently of mean arterial pressure. METHODS: Participants from the international REACH (Reduction of Atherothrombosis for Continued Health) registry, which evaluates subjects with clinical atherothrombotic disease or risk factors for its development, were examined. Those with incomplete 4-year follow-up or PP data (final n = 45,087) were excluded. Univariate and multivariate regression analyses were performed to determine the association between PP and cardiovascular outcomes, including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, all myocardial infarction, all stroke, cardiovascular hospitalization, and a combined outcome. PP was analyzed as a continuous and categorical (i.e., by quartile) variable. RESULTS: The mean age of the cohort was 68 ± 10 years, 35% were women, and 81% were treated for hypertension. The mean blood pressure was 138 ± 19/79 ± 11 mm Hg, rendering a mean PP of 49 ± 16 mm Hg. On univariate analysis, increasing PP quartile was associated with worse outcomes (p < 0.05 for all comparisons). After adjusting for sex, age, current smoking status, history of hypercholesterolemia, history of diabetes, aspirin use, statin use, blood pressure medication use, and mean arterial pressure, PP quartile was still associated with all outcomes except all stroke and cardiovascular death (p < 0.05 for all comparisons). Analysis of PP as a continuous variable yielded similar results. CONCLUSIONS: In an international cohort of high-risk subjects, PP, a readily available hemodynamic parameter, is associated with multiple adverse cardiovascular outcomes and provides prognostic utility beyond that of mean arterial pressure.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

February 2, 2016

Volume

67

Issue

4

Start / End Page

392 / 403

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Thrombosis
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Prognosis
  • Middle Aged
 

Citation

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Selvaraj, S., Steg, P. G., Elbez, Y., Sorbets, E., Feldman, L. J., Eagle, K. A., … REACH Registry Investigators, . (2016). Pulse Pressure and Risk for Cardiovascular Events in Patients With Atherothrombosis: From the REACH Registry. J Am Coll Cardiol, 67(4), 392–403. https://doi.org/10.1016/j.jacc.2015.10.084
Selvaraj, Senthil, Ph Gabriel Steg, Yedid Elbez, Emmanuel Sorbets, Laurent J. Feldman, Kim A. Eagle, E Magnus Ohman, Jacques Blacher, Deepak L. Bhatt, and Deepak L. REACH Registry Investigators. “Pulse Pressure and Risk for Cardiovascular Events in Patients With Atherothrombosis: From the REACH Registry.J Am Coll Cardiol 67, no. 4 (February 2, 2016): 392–403. https://doi.org/10.1016/j.jacc.2015.10.084.
Selvaraj S, Steg PG, Elbez Y, Sorbets E, Feldman LJ, Eagle KA, et al. Pulse Pressure and Risk for Cardiovascular Events in Patients With Atherothrombosis: From the REACH Registry. J Am Coll Cardiol. 2016 Feb 2;67(4):392–403.
Selvaraj, Senthil, et al. “Pulse Pressure and Risk for Cardiovascular Events in Patients With Atherothrombosis: From the REACH Registry.J Am Coll Cardiol, vol. 67, no. 4, Feb. 2016, pp. 392–403. Pubmed, doi:10.1016/j.jacc.2015.10.084.
Selvaraj S, Steg PG, Elbez Y, Sorbets E, Feldman LJ, Eagle KA, Ohman EM, Blacher J, Bhatt DL, REACH Registry Investigators. Pulse Pressure and Risk for Cardiovascular Events in Patients With Atherothrombosis: From the REACH Registry. J Am Coll Cardiol. 2016 Feb 2;67(4):392–403.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

February 2, 2016

Volume

67

Issue

4

Start / End Page

392 / 403

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Thrombosis
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Prognosis
  • Middle Aged