Elevated pulse pressure and cardiovascular risk associated in Spanish population attended in primary care: IBERICAN study

Introduction

Elevated pulse pressure (ePP) is an independent marker of cardiovascular risk (CVR) in people older than 60, and a functional marker of subclinical target organ damage (sTOD) which can predict cardiovascular events in patients with hypertension (HTN), regardless of sTOD.

Objective

To evaluate the prevalence of ePP in adult population seen in primary care and its association with other vascular risk factors, sTOD and with cardiovascular disease (CVD).

Materials and methods

Observational multicentre study conducted in Spain (8,066 patients, 54.5% women) from the prospective cohort study IBERICAN recruited in Primary Care. Pulse pressure (PP) was defined as the difference between the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) ≥60 mmHg. Adjusted (for age and sex) ePP prevalence were determined. Bivariate and multivariate analyses of the possible variables associated with ePP were carried out.

Results

The mean of PP was 52.35 mmHg, and was significantly higher (p < 0.001) in patients with HTN (56.58 vs. 48.45 mmHg) The prevalence of ePP adjusted for age and sex was 23.54% (25.40% men vs. 21.75% women; p < 0.0001). The ePP prevalence rates increased linearly with age (R2 = 0.979) and were significantly more frequent in population aged ≥65 than in population aged <65 (45.47% vs. 20.98%; p < 0.001). HTN, left ventricular hypertrophy, low estimated glomerular filtration rate, alcohol consumption, abdominal obesity, and CVD were independently associated with ePP. 66.27% of patients with ePP had a high or very high CVR, as compared with 36.57% of patients without ePP (OR: 3.41 [95% CI 3.08-3.77]).

Conclusions

The ePP was present in a quarter of our sample, and it was increased with the age. Also, the ePP was more frequent in men, patients with HTN, other TOD (as left ventricular hypertrophy or low estimated glomerular filtration rate) and CVD; because of this, the ePP was associated a higher cardiovascular risk. In our opinion, the ePP is an importer risk marker and its early identification lets to improve better diagnostic and therapeutic management.

Effects of sulfur dioxide and particulate matter pollution on hospital admissions for hypertensive cardiovascular disease: A time series analysis

Background and aims: Air pollution is a major environmental risk factor and the leading cause of disease burden with detrimental effects on cardiovascular systems. Cardiovascular diseases are predisposed by various risk factors, including hypertension, as the most important modifiable risk factor. However, there is a lack of sufficient data concerning the impact of air pollution on hypertension. We sought to study the associations of short-term exposure to Sulfur dioxide (SO₂) and particulate matter (PM₁₀) with the number of daily hospital admissions of hypertensive cardiovascular diseases (HCD). Methods: All hospitalized patients between March 2010 to March 2012 were recruited with the final diagnosis of HCD based on the International Classification of Diseases 10 (codes: I10-I15) from 15 hospitals in Isfahan, one of the most polluted cities in Iran. The 24-hour average concentrations of pollutants were obtained from 4 monitoring stations. In addition to single- and two-pollutant models, we used Negative Binomial and Poisson models with covariates of holidays, dew point, temperature, wind speed, and extracted latent factors of other pollutants controlling for multi-collinearity to examine the risk for hospital admissions for HCD affected by SO₂ and PM₁₀ exposures in the multi-pollutant model. Results: A total of 3132 hospitalized patients (63% female) with a mean (standard deviation) age of 64.96 (13.81) were incorporated in the study. The mean concentrations of SO2 and PM10 were 37.64 μg/m3 and 139.08 μg/m3, respectively. Our findings showed that a significantly increased risk of HCD-induced hospital admission was detected for a 10 μg/m3 increase in the 6-day and 3-day moving average of SO2 and PM₁₀ concentrations in the multi-pollutant model with a percent change of 2.11% (95% confidence interval: 0.61 to 3.63%) and 1.19% (0.33 to 2.05%), respectively. This finding was robust in all models and did not vary by gender (for SO₂ and PM₁₀) and season (for SO₂). However, people aged 35-64 and 18-34 years were vulnerable to SO2 and PM10 exposure-triggered HCD risk, respectively. Conclusions: This study supports the hypothesis of the association between short-term exposure to ambient SO₂ and PM₁₀ and the number of hospital admissions due to HCD.