Association Between Pulse Pressure With All-Cause and Cardiac Mortality in Acute Coronary Syndrome: An Observational Cohort Study

The contribution of cumulative blood pressure load to dementia, cognitive function and mortality in older adults

BACKGROUND

Few studies evaluated the contribution of long-term elevated blood pressure (BP) towards dementia and deaths. We examined the association between cumulative BP (cBP) load and dementia, cognitive decline, all-cause and cardiovascular deaths in older Australians. We also explored whether seated versus standing BP were associated with these outcomes.

METHODS

The Sydney Memory and Aging Study included 1037 community-dwelling individuals aged 70-90 years, recruited from Sydney, Australia. Baseline data was collected in 2005-2007 and the cohort was followed for seven waves until 2021. cSBP load was calculated as the area under the curve (AUC) for SBP ≥140 mmHg divided by the AUC for all SBP values. Cumulative diastolic BP (cDBP) and pulse pressure (cPP) load were calculated using thresholds of 90 mmHg and 60 mmHg. Cox and mixed linear models were used to assess associations.

RESULTS

Of 527 participants with both seated and standing BP data (47.7% men, median age 77), 152 (28.8%) developed dementia over a mean follow-up of 10.5 years. Higher cPP load was associated with a higher risk of all-cause deaths, and cSBP load was associated with a higher risk of cardiovascular deaths in multivariate models ( P for trend < 0.05). Associations between cPP load, dementia and cognitive decline lost statistical significance after adjustment for age. Differences between sitting and standing BP load were not associated with the outcomes.

CONCLUSION

Long-term cPP load was associated with a higher risk of all-cause deaths and cSBP load associated with a higher risk of cardiovascular deaths in older Australians.

Pulse pressure and inferior wall ST-segment elevation myocardial infarction: investigating mortality, hospital major cardiovascular events, and long-term prognosis

Inferior Wall ST-Segment Elevation Myocardial Infarction (INF STEMI) is a severe condition with high mortality. Rapid treatment with Primary Percutaneous Coronary Intervention (PPCI) is preferred. Pulse Pressure (PP) is a known risk factor for both cardiovascular disease and may be a valuable predictor of outcomes in these patients. The study aims to evaluate the relationship between PP and long-term prognosis, mortality, and major cardiovascular events after inferior STEMI in cases who underwent PPCI. This cross-sectional study included subjects with a confirmed diagnosis of inferior STEMI who underwent PPCI. Patient data were gathered from hospital records and analyzed for the relationship between PP and MACE during hospitalization and one-year follow-up. Statistical analysis was performed using SPSS. This cross-sectional study of 320 cases found that DM, DBP, and Cr patients had a higher incidence of MACEs (P-value #x003C;0.05). Subjects with higher LVEF and SBP had fewer MACEs (P-value #x003C;0.05). Cases with a PP of ≤50 had a higher mortality and heart failure incidence during hospitalization than those with a PP >50 (P-value #x003C;0.05). However, the two groups had no significant difference in one-year MACE rates. The study found that increasing DBP, Cr, and DM and decreasing LVEF and SBP impacted MACE incidence. PP ≤50 had more heart failure incidence and mortality during hospitalization in patients with inferior STEMI.

Association of pulse pressure with all-cause mortality in older Japanese patients with type 2 diabetes mellitus: A observational cohort study

AIM

Although systolic and diastolic blood pressures as well as blood glucose are monitored when nurses care for patients with type 2 diabetes, the same is not true for pulse pressure. We aimed to determine the association between pulse pressure and all-cause mortality.

METHODS

We conducted a longitudinal study of outpatients with type 2 diabetes aged 65 years and older at diabetes-specialized hospitals in Japan from September 2004 to December 2016. Descriptive data, blood pressure measurements, blood analysis data, and information on life and death were obtained from medical records. Cox proportional hazards models were used to estimate the relative risks with 95% confidence intervals for all-cause mortality.

RESULTS

We analyzed 357 of the 383 recruited patients (mean age, 74.9 years; 175 men and 182 women; average follow-up, 7.7 years), and 50 patients died. After adjusting for covariates, the relative risks for pulse pressures of 55 to <65, 65 to <75, and ≥75 mmHg (reference: <55 mmHg) were 1.77 (95% confidence interval: [0.59, 5.28]), 2.66 (95% confidence interval: [0.93, 7.56]), and 3.23 (95% confidence interval: [1.16, 8.99]), respectively. The relative risk for the 65 mmHg or higher group (reference: <65 mmHg) was 2.08 (95% confidence interval: [1.11, 3.92]). Neither systolic blood pressure nor diastolic blood pressure alone were significantly associated with mortality.

CONCLUSIONS

In older patients with type 2 diabetes, a wide pulse pressure was associated with a higher risk of all-cause mortality. Nurses caring for older people with diabetes should also monitor pulse pressure.