Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor

Jesus D Melgarejo; Lutgarde Thijs; Dong-Mei Wei; Michael Bursztyn; Wen-Yi Yang; Yan Li; Kei Asayama; Tine W Hansen; Masahiro Kikuya; Takayoshi Ohkubo; Eamon Dolan; Katarzyna Stolarz-Skrzypek; Yi-Bang Cheng; Valérie Tikhonoff; Sofia Malyutina; Edoardo Casiglia; Lars Lind; Edgardo Sandoya; Jan Filipovský; Krzysztof Narkiewicz; Natasza Gilis-Malinowska; Kalina Kawecka-Jaszcz; José Boggia; Ji-Guang Wang; Yutaka Imai; Peter Verhamme; Sander Trenson; Stefan Janssens; Eoin O'Brien; Gladys E Maestre; Benjamin Gavish; Jan A Staessen; Zhen-Yu Zhang

doi:10.1093/ajh/hpab048

Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor

Jesus D Melgarejo, Lutgarde Thijs, Dong-Mei Wei, Michael Bursztyn, Wen-Yi Yang, Yan Li, Kei Asayama, Tine W Hansen, Masahiro Kikuya, Takayoshi Ohkubo, Eamon Dolan, Katarzyna Stolarz-Skrzypek, Yi-Bang Cheng, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Lars Lind, Edgardo Sandoya, Jan Filipovský, Krzysztof NarkiewiczNatasza Gilis-Malinowska, Kalina Kawecka-Jaszcz, José Boggia, Ji-Guang Wang, Yutaka Imai, Peter Verhamme, Sander Trenson, Stefan Janssens, Eoin O'Brien, Gladys E Maestre, Benjamin Gavish, Jan A Staessen, Zhen-Yu Zhang

Steno Diabetes Center Copenhagen

17 Citationer (Scopus)

Abstract

BACKGROUND: Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan.

METHODS: In 4,663 young (18-49 years) and 7,185 older adults (≥50 years), brachial PP was recorded over 24 hours. Total mortality and all major cardiovascular events (MACEs) combined were coprimary endpoints. Cardiovascular death, coronary events, and stroke were secondary endpoints.

RESULTS: In young adults (median follow-up, 14.1 years; mean PP, 45.1 mm Hg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1,000 person-years. The adjusted hazard ratios expressed per 10-mm Hg PP increments were less than unity (P ≤ 0.027) for MACE (0.67; 95% confidence interval [CI], 0.47-0.96) and cardiovascular death (0.33; 95% CI, 0.11-0.75). In older adults (median follow-up, 13.1 years; mean PP, 52.7 mm Hg), the endpoint rates, expressing absolute risk, ranged from 22.5 to 45.4 per 1,000 person-years and the adjusted hazard ratios, reflecting relative risk, from 1.09 to 1.54 (P < 0.0001). The PP-related relative risks of death, MACE, and stroke decreased >3-fold from age 55 to 75 years, whereas absolute risk rose by a factor 3.

CONCLUSIONS: From 50 years onwards, the PP-related relative risk decreases, whereas absolute risk increases. From a lifecourse perspective, young adulthood provides a window of opportunity to manage risk factors and prevent target organ damage as forerunner of premature death and MACE. In older adults, treatment should address absolute risk, thereby extending life in years and quality.

Originalsprog	Engelsk
Tidsskrift	American Journal of Hypertension
Vol/bind	34
Udgave nummer	9
Sider (fra-til)	929-938
Antal sider	10
ISSN	0895-7061
DOI	https://doi.org/10.1093/ajh/hpab048
Status	Udgivet - 22 sep. 2021

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Melgarejo, J. D., Thijs, L., Wei, D.-M., Bursztyn, M., Yang, W.-Y., Li, Y., Asayama, K., Hansen, T. W., Kikuya, M., Ohkubo, T., Dolan, E., Stolarz-Skrzypek, K., Cheng, Y.-B., Tikhonoff, V., Malyutina, S., Casiglia, E., Lind, L., Sandoya, E., Filipovský, J., ... Zhang, Z.-Y. (2021). Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor. American Journal of Hypertension, 34(9), 929-938. https://doi.org/10.1093/ajh/hpab048

Melgarejo, JD, Thijs, L, Wei, D-M, Bursztyn, M, Yang, W-Y, Li, Y, Asayama, K, Hansen, TW, Kikuya, M, Ohkubo, T, Dolan, E, Stolarz-Skrzypek, K, Cheng, Y-B, Tikhonoff, V, Malyutina, S, Casiglia, E, Lind, L, Sandoya, E, Filipovský, J, Narkiewicz, K, Gilis-Malinowska, N, Kawecka-Jaszcz, K, Boggia, J, Wang, J-G, Imai, Y, Verhamme, P, Trenson, S, Janssens, S, O'Brien, E, Maestre, GE, Gavish, B, Staessen, JA & Zhang, Z-Y 2021, 'Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor', American Journal of Hypertension, bind 34, nr. 9, s. 929-938. https://doi.org/10.1093/ajh/hpab048

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title = "Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor",

abstract = "BACKGROUND: Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan.METHODS: In 4,663 young (18-49 years) and 7,185 older adults (≥50 years), brachial PP was recorded over 24 hours. Total mortality and all major cardiovascular events (MACEs) combined were coprimary endpoints. Cardiovascular death, coronary events, and stroke were secondary endpoints.RESULTS: In young adults (median follow-up, 14.1 years; mean PP, 45.1 mm Hg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1,000 person-years. The adjusted hazard ratios expressed per 10-mm Hg PP increments were less than unity (P ≤ 0.027) for MACE (0.67; 95% confidence interval [CI], 0.47-0.96) and cardiovascular death (0.33; 95% CI, 0.11-0.75). In older adults (median follow-up, 13.1 years; mean PP, 52.7 mm Hg), the endpoint rates, expressing absolute risk, ranged from 22.5 to 45.4 per 1,000 person-years and the adjusted hazard ratios, reflecting relative risk, from 1.09 to 1.54 (P < 0.0001). The PP-related relative risks of death, MACE, and stroke decreased >3-fold from age 55 to 75 years, whereas absolute risk rose by a factor 3.CONCLUSIONS: From 50 years onwards, the PP-related relative risk decreases, whereas absolute risk increases. From a lifecourse perspective, young adulthood provides a window of opportunity to manage risk factors and prevent target organ damage as forerunner of premature death and MACE. In older adults, treatment should address absolute risk, thereby extending life in years and quality.",

keywords = "arterial stiffness, blood pressure, cardiovascular disease, hypertension, mortality, population science, pulse pressure",

author = "Melgarejo, {Jesus D} and Lutgarde Thijs and Dong-Mei Wei and Michael Bursztyn and Wen-Yi Yang and Yan Li and Kei Asayama and Hansen, {Tine W} and Masahiro Kikuya and Takayoshi Ohkubo and Eamon Dolan and Katarzyna Stolarz-Skrzypek and Yi-Bang Cheng and Val{\'e}rie Tikhonoff and Sofia Malyutina and Edoardo Casiglia and Lars Lind and Edgardo Sandoya and Jan Filipovsk{\'y} and Krzysztof Narkiewicz and Natasza Gilis-Malinowska and Kalina Kawecka-Jaszcz and Jos{\'e} Boggia and Ji-Guang Wang and Yutaka Imai and Peter Verhamme and Sander Trenson and Stefan Janssens and Eoin O'Brien and Maestre, {Gladys E} and Benjamin Gavish and Staessen, {Jan A} and Zhen-Yu Zhang",

note = "{\textcopyright} The Author(s) 2021. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd.",

year = "2021",

month = sep,

day = "22",

doi = "10.1093/ajh/hpab048",

language = "English",

volume = "34",

pages = "929--938",

journal = "American Journal of Hypertension",

issn = "0895-7061",

publisher = "Oxford University Press",

number = "9",

}

TY - JOUR

T1 - Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor

AU - Melgarejo, Jesus D

AU - Thijs, Lutgarde

AU - Wei, Dong-Mei

AU - Bursztyn, Michael

AU - Yang, Wen-Yi

AU - Li, Yan

AU - Asayama, Kei

AU - Hansen, Tine W

AU - Kikuya, Masahiro

AU - Ohkubo, Takayoshi

AU - Dolan, Eamon

AU - Stolarz-Skrzypek, Katarzyna

AU - Cheng, Yi-Bang

AU - Tikhonoff, Valérie

AU - Malyutina, Sofia

AU - Casiglia, Edoardo

AU - Lind, Lars

AU - Sandoya, Edgardo

AU - Filipovský, Jan

AU - Narkiewicz, Krzysztof

AU - Gilis-Malinowska, Natasza

AU - Kawecka-Jaszcz, Kalina

AU - Boggia, José

AU - Wang, Ji-Guang

AU - Imai, Yutaka

AU - Verhamme, Peter

AU - Trenson, Sander

AU - Janssens, Stefan

AU - O'Brien, Eoin

AU - Maestre, Gladys E

AU - Gavish, Benjamin

AU - Staessen, Jan A

AU - Zhang, Zhen-Yu

PY - 2021/9/22

Y1 - 2021/9/22

N2 - BACKGROUND: Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan.METHODS: In 4,663 young (18-49 years) and 7,185 older adults (≥50 years), brachial PP was recorded over 24 hours. Total mortality and all major cardiovascular events (MACEs) combined were coprimary endpoints. Cardiovascular death, coronary events, and stroke were secondary endpoints.RESULTS: In young adults (median follow-up, 14.1 years; mean PP, 45.1 mm Hg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1,000 person-years. The adjusted hazard ratios expressed per 10-mm Hg PP increments were less than unity (P ≤ 0.027) for MACE (0.67; 95% confidence interval [CI], 0.47-0.96) and cardiovascular death (0.33; 95% CI, 0.11-0.75). In older adults (median follow-up, 13.1 years; mean PP, 52.7 mm Hg), the endpoint rates, expressing absolute risk, ranged from 22.5 to 45.4 per 1,000 person-years and the adjusted hazard ratios, reflecting relative risk, from 1.09 to 1.54 (P < 0.0001). The PP-related relative risks of death, MACE, and stroke decreased >3-fold from age 55 to 75 years, whereas absolute risk rose by a factor 3.CONCLUSIONS: From 50 years onwards, the PP-related relative risk decreases, whereas absolute risk increases. From a lifecourse perspective, young adulthood provides a window of opportunity to manage risk factors and prevent target organ damage as forerunner of premature death and MACE. In older adults, treatment should address absolute risk, thereby extending life in years and quality.

AB - BACKGROUND: Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan.METHODS: In 4,663 young (18-49 years) and 7,185 older adults (≥50 years), brachial PP was recorded over 24 hours. Total mortality and all major cardiovascular events (MACEs) combined were coprimary endpoints. Cardiovascular death, coronary events, and stroke were secondary endpoints.RESULTS: In young adults (median follow-up, 14.1 years; mean PP, 45.1 mm Hg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1,000 person-years. The adjusted hazard ratios expressed per 10-mm Hg PP increments were less than unity (P ≤ 0.027) for MACE (0.67; 95% confidence interval [CI], 0.47-0.96) and cardiovascular death (0.33; 95% CI, 0.11-0.75). In older adults (median follow-up, 13.1 years; mean PP, 52.7 mm Hg), the endpoint rates, expressing absolute risk, ranged from 22.5 to 45.4 per 1,000 person-years and the adjusted hazard ratios, reflecting relative risk, from 1.09 to 1.54 (P < 0.0001). The PP-related relative risks of death, MACE, and stroke decreased >3-fold from age 55 to 75 years, whereas absolute risk rose by a factor 3.CONCLUSIONS: From 50 years onwards, the PP-related relative risk decreases, whereas absolute risk increases. From a lifecourse perspective, young adulthood provides a window of opportunity to manage risk factors and prevent target organ damage as forerunner of premature death and MACE. In older adults, treatment should address absolute risk, thereby extending life in years and quality.

KW - arterial stiffness

KW - blood pressure

KW - cardiovascular disease

KW - hypertension

KW - mortality

KW - population science

KW - pulse pressure

UR - http://www.scopus.com/inward/record.url?scp=85114517823&partnerID=8YFLogxK

U2 - 10.1093/ajh/hpab048

DO - 10.1093/ajh/hpab048

M3 - Journal article

C2 - 33687055

SN - 0895-7061

VL - 34

SP - 929

EP - 938

JO - American Journal of Hypertension

JF - American Journal of Hypertension

IS - 9

ER -

Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor

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