Association of pulse pressure with cardiovascular outcome is independent of left ventricular hypertrophy and systolic dysfunction: The strong heart study

Background: Whether increased pulse pressure (PP) predicts cardiovascular (CV) events independent of left ventricular hypertrophy (LVH) and systolic dysfunction is unclear. Methods: Strong Heart Study adults (2946) without clinically overt coronary heart disease were studied. Echocardiographic LV mass > 49.2 g/m(2.7) in men or > 46.7 g/m(2.7) in women defined LVH. Clinical, metabolic, and echocardiographic characteristics were evaluated among participants divided in quartiles of PP (cut points: 42, 52, and 64 mm Hg). Mean follow-up for evaluation of all-cause and CV mortality was approximately 7 years. Results: Mean age, proportion of women, and proportion of participants with diabetes increased across quartiles of PP. Partially by definition, the proportion of participants with hypertension was also higher with wider PP. Systolic and mean blood pressure (BP) increased whereas diastolic BP did not differ significantly across quartiles of PP. The LV mass index was higher whereas ejection fraction (EF) tended to be lower with wider PP. The CV mortality and all-cause mortality were higher in the highest quartile of PP. Wider PP predicted CV mortality independently of traditional risk factors, LVH and reduced EF. Conclusions: Wider PP was associated with a higher C hazard ratio of CV mortality independent of traditional CV risk factors, LVH and reduced EF in adults without overt coronary heart disease.