Ambulatory pulse pressure components: concept, determination and clinical relevance
Abstract
Ambulatory pulse pressure (PP) a well known predictor of mortality, is widely believed to be a marker for arterial stiffness. However stiffness itself is pressure-dependent. Developing a model-based method for splitting PP into two components expressing the contribution of a pressure-independent stiffness ('elastic', elPP) and the pressure-dependence of stiffness ('stiffening', stPP), and investigating their predictive power for all-cause mortality. Deriving quantitative expressions for elPP and stPP assuming an exponential pressure-volume relationship in arteries, calculated from ambulatory blood pressure (BP) data and estimate standardized hazard ratios with Cox proportional hazards regression in selected patient groups. Ambulatory BP records of 1999 consecutive hypertensive patients, of whom 103 died from all causes within 5 years, were analyzed. PP, elPP, stPP and stPP/elPP (PP variables) (mean ± SD) were 60 ± 14, 50 ± 10, 10 ± 8 and 0.20 ± 0.14 mmHg, respectively. elPP and stPP were weakly correlated (r = 0.21). Predictive power was found for patients with heart rate less than 70: mean [95% confidence interval] (P value) hazard ratio of PP, stPP and stPP/elPP (adjusted) were 1.48 [1.13-1.95] (P = 0.005), 1.58 [1.20-2.09] (...Continue Reading
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