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Independent prognostic information provided by sphygmomanometrically determined pulse pressure and mean arterial pressure in patients with left ventricular dysfunction . OBJECTIVES The purpose of this study was to evaluate the relationship of baseline pulse pressure and mean arterial pressure to mortality in patients with left ventricular dysfunction . BACKGROUND Increased conduit vessel stiffness increases pulse pressure and pulsatile load , potentially contributing to adverse outcomes in patients with left ventricular dysfunction . METHODS Pulse and mean arterial pressure were analyzed for their effect on mortality , adjusting for other modifiers of risk , using Cox proportional hazards regression analysis of data collected from 6,781 patients randomized into the Studies of Left Ventricular Dysfunction trials . RESULTS Pulse and mean arterial pressure were related positively to each other , age , ejection fraction and prevalence of diabetes and hypertension and inversely to prior myocardial infarction and beta-adrenergic blocking agent use . Higher pulse pressure was associated with increased prevalence of female gender , greater calcium channel blocking agent , digoxin and diuretic use , lower heart rate and a higher rate of reported smoking history . Higher mean arterial pressure was associated with higher heart rate , lower calcium channel blocker and digoxin use and lower New York Heart Association functional class . Over a 61-month follow-up 1,582 deaths ( 1,397 cardiovascular ) occurred . In a multivariate analysis adjusting for the above covariates and treatment assignment , higher pulse pressure remained an independent predictor of total and cardiovascular mortality ( total mortality relative risk , 1.05 per 10 mm Hg increment ; 95 % confidence interval , 1.01 to 1.10 ; p = 0.02 ) . Mean arterial pressure was inversely related to total and cardiovascular mortality ( total mortality relative risk , 0.89 ; 95 % confidence interval , 0.85 to 0.94 ; p < 0.0001 ) . CONCLUSIONS One noninvasive blood pressure measurement provides two independent prognostic factors for survival . Increased conduit vessel stiffness , as assessed by pulse pressure , may contribute to increased mortality in patients with left ventricular dysfunction , independent of mean arterial pressure .
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Intervention_Physical
sphygmomanometrically determined pulse pressure and mean arterial pressure
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Intervention_Pharmacological
calcium channel blocking agent
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Intervention_Physical
,
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Intervention_Pharmacological
digoxin
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Intervention_Pharmacological
diuretic
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Intervention_Pharmacological
calcium channel blocker
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Intervention_Pharmacological
digoxin
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Intervention_Physical
noninvasive blood pressure measurement
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Outcome_Physical
pulse pressure
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Outcome_Physical
arterial pressure
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Outcome_Mortality
mortality
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Outcome_Physical
Pulse and mean arterial pressure
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Outcome_Physical
Higher pulse pressure
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Outcome_Physical
Higher mean arterial pressure
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Outcome_Mortality
deaths
272
Outcome_Physical
pulse pressure
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Outcome_Mortality
total and cardiovascular mortality
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Outcome_Physical
Mean arterial pressure
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Outcome_Mortality
total and cardiovascular mortality
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Outcome_Mortality
survival
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Outcome_Physical
Increased conduit vessel stiffness
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Outcome_Mortality
mortality
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Participant_Condition
left ventricular dysfunction
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Participant_Sample-size
6,781