Nighttime ambulatory pulse pressure predicts cardiovascular and all-cause mortality among middle-aged participants in the 21-year follow-up

Abstract

<div lang="en" class="abs"><p class="abs_header">Abstract</p><p>Office pulse pressure (PP) is a predictor for cardiovascular (CV) events and mortality. Our aim was to evaluate ambulatory PP as a long-term risk factor in a random cohort of middle-aged participants. The Opera study took place in years 1991–1993, with a 24-h ambulatory blood pressure measurement (ABPM) performed to 900 participants. The end-points were non-fatal and fatal CV events, and deaths of all-causes. Follow-up period, until the first event or until the end of the year 2014, was 21.1 years (mean). Of 900 participants, 22.6% died (29.6% of men/15.6% of women, <em>p</em><.001). A CV event was experienced by 208 participants (23.1%), 68.3% of them were male (<em>p</em><.001). High nighttime ambulatory PP predicted independently CV mortality (hazard ratio [HR] 2.60; 95% confidence interval [CI 95%] 1.08–6.31, <em>p</em>=.034) and all-cause mortality in the whole population (HR 1.72; Cl 95% 1.06–2.78, <em>p</em>=.028). In males, both 24-h PP and nighttime PP associated with CV mortality and all-cause mortality (24-h PP HR for CV mortality 2.98; CI 95% 1.11–8.04, <em>p</em>=.031 and all-cause mortality HR 2.40; CI 95% 1.32–4.37, <em>p</em>=.004). Accordingly, nighttime PP; HR for CV mortality 3.13; CI 95% 1.14–8.56, <em>p</em>=.026, and for all-cause mortality HR 2.26; CI 95% 1.29–3.96, <em>p</em>=.004. Cox regression analyses were adjusted by sex, CV risk factors, and appropriate ambulatory mean systolic BP. In our study, high ambulatory nighttime PP was detected as a long-term risk factor for CV and all-cause mortality in middle-aged individuals.</p></div>