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Should pulse pressure become part of the Framingham risk score?
J Hum Hypertens 2004; 18(4):279-86JH

Abstract

An increased pulse pressure suggests aortic stiffening. New evidence also suggests that pulse pressure is a more sensitive measure of risk than other indexes of blood pressure in middle-aged and older persons. The objective of the study was to relate pulse pressure to the risk of cardiovascular events in the general population, and to assess whether pulse pressure could improve the Framingham risk prediction. A total of 378 men and 391 women over the age of 50 years (mean 62.7 years) were followed. Sex-specific Framingham cardiovascular risk scores were derived from age, systolic pressure, diastolic pressure, total and HDL cholesterol, smoking status and the presence or absence of diabetes mellitus. The cutoff points used to develop a pulse pressure score were calculated by determining the percentile points corresponding to the blood pressure categories in the Framingham risk score. We calculated relative hazard rates by multiple Cox regression. After a median follow-up of 7.2 years (range: 11 months-15 years), a total of 148 cardiovascular events occurred. In Cox regression analysis, a 10 mmHg higher pulse pressure was associated with 31% (P<0.0001) increase in the risk for cardiovascular events (fatal and nonfatal) after adjustment for sex, age, total and HDL cholesterol, smoking and the presence of diabetes mellitus. After adjustment for the aforementioned risk factors, a one-point increment in the blood pressure and pulse pressure scores was associated with a 40 and 48% (both P<0.0001) increase in the risk of fatal and nonfatal cardiovascular events, respectively. When both the blood pressure and pulse pressure scores were forced into a Cox model, only the pulse pressure score remained statistically significant (P<0.0001) with a relative hazard rate of 1.37 (CI: 1.16-1.69). These prospective data suggest that pulse pressure may improve the Framingham risk prediction among middle-aged and older individuals. Further studies, especially in the Framingham cohort, are warranted.

Authors+Show Affiliations

Studiecoördinatiecentrum, Laboratorium hypertensie, Departement Moleculair en Cardiovasculair Onderzoek, Katholieke Universiteit Leuven, Leuven, Belgium. tim.nawrot@med.kuleuven.ac.beNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15037878

Citation

Nawrot, T S., et al. "Should Pulse Pressure Become Part of the Framingham Risk Score?" Journal of Human Hypertension, vol. 18, no. 4, 2004, pp. 279-86.
Nawrot TS, Staessen JA, Thijs L, et al. Should pulse pressure become part of the Framingham risk score? J Hum Hypertens. 2004;18(4):279-86.
Nawrot, T. S., Staessen, J. A., Thijs, L., Fagard, R. H., Tikhonoff, V., Wang, J. G., & Franklin, S. S. (2004). Should pulse pressure become part of the Framingham risk score? Journal of Human Hypertension, 18(4), pp. 279-86.
Nawrot TS, et al. Should Pulse Pressure Become Part of the Framingham Risk Score. J Hum Hypertens. 2004;18(4):279-86. PubMed PMID: 15037878.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Should pulse pressure become part of the Framingham risk score? AU - Nawrot,T S, AU - Staessen,J A, AU - Thijs,L, AU - Fagard,R H, AU - Tikhonoff,V, AU - Wang,J-G, AU - Franklin,S S, PY - 2004/3/24/pubmed PY - 2004/11/9/medline PY - 2004/3/24/entrez SP - 279 EP - 86 JF - Journal of human hypertension JO - J Hum Hypertens VL - 18 IS - 4 N2 - An increased pulse pressure suggests aortic stiffening. New evidence also suggests that pulse pressure is a more sensitive measure of risk than other indexes of blood pressure in middle-aged and older persons. The objective of the study was to relate pulse pressure to the risk of cardiovascular events in the general population, and to assess whether pulse pressure could improve the Framingham risk prediction. A total of 378 men and 391 women over the age of 50 years (mean 62.7 years) were followed. Sex-specific Framingham cardiovascular risk scores were derived from age, systolic pressure, diastolic pressure, total and HDL cholesterol, smoking status and the presence or absence of diabetes mellitus. The cutoff points used to develop a pulse pressure score were calculated by determining the percentile points corresponding to the blood pressure categories in the Framingham risk score. We calculated relative hazard rates by multiple Cox regression. After a median follow-up of 7.2 years (range: 11 months-15 years), a total of 148 cardiovascular events occurred. In Cox regression analysis, a 10 mmHg higher pulse pressure was associated with 31% (P<0.0001) increase in the risk for cardiovascular events (fatal and nonfatal) after adjustment for sex, age, total and HDL cholesterol, smoking and the presence of diabetes mellitus. After adjustment for the aforementioned risk factors, a one-point increment in the blood pressure and pulse pressure scores was associated with a 40 and 48% (both P<0.0001) increase in the risk of fatal and nonfatal cardiovascular events, respectively. When both the blood pressure and pulse pressure scores were forced into a Cox model, only the pulse pressure score remained statistically significant (P<0.0001) with a relative hazard rate of 1.37 (CI: 1.16-1.69). These prospective data suggest that pulse pressure may improve the Framingham risk prediction among middle-aged and older individuals. Further studies, especially in the Framingham cohort, are warranted. SN - 0950-9240 UR - https://www.unboundmedicine.com/medline/citation/15037878/Should_pulse_pressure_become_part_of_the_Framingham_risk_score L2 - http://dx.doi.org/10.1038/sj.jhh.1001669 DB - PRIME DP - Unbound Medicine ER -