Pulse Pressure and Risk of Cardiovascular Events

Study Questions:

What is the relationship between pulse pressure (PP) and adverse cardiovascular events using data from the REACH (Reduction of Atherothrombosis for Continued Health) registry?


The investigators examined participants from the international REACH registry, which evaluates individuals with clinical atherothrombotic disease or risk factors for its development. They excluded those with incomplete 4-year follow-up or PP data (n = 45,087). Univariable and multivariable 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.


The mean age of the cohort was 68 ± 10 years, 35% were female, 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 univariable 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.


The authors concluded that PP is associated with multiple adverse cardiovascular outcomes and provides prognostic utility beyond that of mean arterial pressure.


This study reports that higher PP conferred an increased risk for multiple adverse cardiovascular events. The adverse relationships persisted between PP and several adverse outcomes, notably the combined outcome of cardiovascular death, cardiovascular hospitalization, nonfatal MI, and nonfatal stroke, after controlling for several potential confounding risk factors, including mean arterial pressure. Since PP is easily calculated from blood pressure, its clinical utility would be potentially high. Reduction in PP may serve as a therapeutic target, but future research is necessary to delineate its role more precisely.

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