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(Circulation. 2001;104:783.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Effect of Aging on the Prognostic Significance of Ambulatory Systolic, Diastolic, and Pulse Pressure in Essential Hypertension

Rajdeep S. Khattar, BM, MRCP; John D. Swales, MA, MD, FRCP; Caroline Dore, BSc; Roxy Senior, DM, MRCP; Avijit Lahiri, MB, BS, MSc, MRCP

From the Department of Cardiovascular Medicine, Northwick Park and St. Mark’s Hospital NHS Trust and Institute for Medical Research, Harrow, Middlesex (R.S.K., R.S, A.L.); the Cardiovascular Research Institute, University of Leicester, Leicester Royal Infirmary, Leicester (J.D.S.); and the Department of Medical Statistics and Evaluation, Imperial College School of Medicine, Hammersmith Hospital, London, UK (C.D.).

Correspondence to A. Lahiri. MB, BS, MSc, MRCP, FACC, FESC, Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, Middlesex, United Kingdom HA1 3UJ. E-mail nphcardiology{at}netscapeonline.co.uk

Background— This study compared the relative prognostic significance of 24 hour intra-arterial ambulatory systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) parameters in middle-aged versus elderly hypertensives.

Methods and Results— A total of 546 subjects aged <60 years and 142 subjects aged 60 years who had undergone baseline pretreatment 24-hour intra-arterial ambulatory blood pressure monitoring were followed for 9.2±4.1 years. Multivariate analysis showed that in younger subjects, 24-hour, daytime, and nighttime DBP, MAP, and SBP, when considered individually, were positively related to morbid events; DBP parameters provided the best predictive values. In the group 60 years (elderly group), 24-hour, daytime, and nighttime PP and SBP were the most predictive parameters, whereas ambulatory DBP and MAP measurements failed to provide any prognostic value. When 24-hour values of SBP and DBP were jointly included in the baseline model, DBP (z=2.02, P=0.04) but not SBP (z=-0.43, P=0.67) was related to outcome in younger subjects, whereas in the elderly group, SBP (z=3.33, P=0.001) was positively and DBP (z=-1.75, P=0.07) was negatively related to outcome. Clinic blood pressure measurements failed to provide any independent prognostic value in either age group.

Conclusions— The relative prognostic significance of ambulatory blood pressure components depends on age; DBP parameters provided the best prognostic value in middle-aged individuals, whereas PP parameters were the most predictive in the elderly. This may reflect differing underlying hemodynamic mechanisms of hypertension in these age groups.

Key Words: aging • blood pressure • prognosis

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