CONTEXT: Arterial stiffness increases with age. Thus, pulse pressure, an index of arterial stiffening, may predict congestive heart failure (CHF) in the elderly. OBJECTIVE: To study prospectively the association between pulse pressure and risk of CHF. DESIGN: Prospective cohort study. SETTING: The community-based East Boston Senior Health Project, East Boston, Mass. PATIENTS: A total of 1621 men and women (mean [SD] age, 77.9 [5.0] years) free of CHF who had blood pressure measurements taken in 1988-1989 and were followed up for 3.8 years. MAIN OUTCOME MEASURE: Incidence of CHF as ascertained by hospital discharge diagnosis (n = 208) and death certificates (n = 13). RESULTS: After controlling for age, sex, mean arterial pressure, history of coronary heart disease, diabetes mellitus, atrial fibrillation, valvular heart disease, and antihypertensive medication use, pulse pressure was an independent predictor of CHF. For each 10-mm Hg elevation in pulse pressure, there was a 14% increase in risk of CHF (95% confidence interval, 1.05-1.24; P = .003). Those in the highest tertile of pulse pressure (>67 mm Hg) had a 55% increased risk of CHF (P=.02) compared with those in the lowest (<54 mm Hg). Pulse pressure was more predictive than systolic blood pressure alone and was independent of diastolic blood pressure. CONCLUSION: Pulse pressure, an easily measurable correlate of pulsatile hemodynamic load, is an independent predictor of risk of CHF in this elderly cohort.
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机译：背景：动脉僵硬度随年龄增长而增加。因此，脉搏压力是动脉硬化的指标，可以预测老年人的充血性心力衰竭（CHF）。目的：前瞻性研究脉压与CHF风险之间的关系。设计：前瞻性队列研究。地点：马萨诸塞州东波士顿市，社区为基础的东波士顿高级卫生项目患者：1988年进行血压测量的总共1621名男女（平均[SD]年龄，77.9 [5.0]岁）没有瑞士法郎。 -1989年，随访3.8年。主要观察指标：通过出院诊断（n = 208）和死亡证明（n = 13）确定的CHF发生率。结果：在控制了年龄，性别，平均动脉压，冠心病，糖尿病，心房颤动，瓣膜性心脏病和使用降压药的使用后，脉压是CHF的独立预测因子。脉搏压力每升高10 mm Hg，CHF风险增加14％（95％置信区间1.05-1.24; P = 0.003）。与最低压力脉动压力（<54 mm Hg）相比，脉压最高压力（> 67 mm Hg）的患者发生CHF的风险增加55％（P = .02）。脉压比单独的收缩压更具预测性，并且与舒张压无关。结论：脉压是脉搏血流动力学负荷的易于测量的相关因素，是该老年队列人群CHF风险的独立预测因子。
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