Pulse pressure and subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis

Am J Hypertens. 2013 May;26(5):636-42. doi: 10.1093/ajh/hps092. Epub 2013 Feb 6.

Abstract

Background: Brachial pulse pressure (PP) has been found to be associated with markers of subclinical cardiovascular disease, including carotid intima-media thickness and left-ventricular mass index (LVMI), but it is unclear whether these associations are independent of traditional cardiovascular risk factors and of the steady, nonpulsatile component of blood pressure (BP). Moreover, it is unknown whether these associations are modified by gender, age, or race/ethnicity.

Methods: We used multivariate linear regression models to assess the relationship between brachial PP and three markers of subclinical cardiovascular disease (CVD) (common carotid intima-media thickness (CC-IMT), internal carotid intima-media thickness (IC-IMT), and LVMI) in four race/ethnic groups in the Multi-Ethnic Study of Atherosclerosis. The models were adjusted for traditional Framingham risk factors (age, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, diabetes, smoking status), use of lipid-lowering medication, use of antihypertensive medication, study site, and mean arterial pressure (MAP).

Results: The assessment was done on 6,776 participants (2,612 non-Hispanic white, 1,870 African-American, 1,494 Hispanic, and 800 Chinese persons). The associations between brachial PP and CC-IMT, IC-IMT, and LVMI were significant in fully adjusted models. The three subclinical markers also showed significant interactions with gender (P < 0.0001), with stronger interactions in men. There was an interaction with age for LVMI (P = 0.004) and IC-IMT (P = 0.008). Race/ethnicity modified the association of PP with CC-IMT.

Conclusions: Brachial PP was independently associated with subclinical CVD after adjustment for cardiovascular risk factors and mean arterial pressure (MAP). The strength of the association differed significantly for strata of gender, age, and race/ethnicity.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • African Americans*
  • Aged
  • Aged, 80 and over
  • Asians*
  • Atherosclerosis / epidemiology*
  • Atherosclerosis / ethnology*
  • Atherosclerosis / pathology
  • Atherosclerosis / physiopathology
  • Biomarkers
  • Blood Pressure / physiology*
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / ethnology*
  • Cardiovascular Diseases / physiopathology
  • Carotid Arteries / diagnostic imaging
  • Carotid Arteries / pathology
  • Carotid Intima-Media Thickness
  • Cohort Studies
  • Female
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / pathology
  • Hispanic or Latino*
  • Humans
  • Incidence
  • Linear Models
  • Male
  • Middle Aged
  • Risk Factors
  • Whites*

Substances

  • Biomarkers

Supplementary concepts

  • Carotid Intimal Medial Thickness 1