Clinical Research
Cardiovascular Risk
Sex Difference in Cardiovascular Risk: Role of Pulse Pressure Amplification

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Objectives

The study was to explore whether the brachial/carotid pulse pressure (B/C-PP) ratio selectively predicts the sex difference in age-related cardiovascular (CV) death.

Background

Hypertension and CV complications are more severe in men and post-menopausal women than in pre-menopausal women. C-PP is lower than B-PP, and the B/C-PP ratio is a physiological marker of PP amplification between B and C arteries that tends toward 1.0 with age.

Methods

The study involved 72,437 men (ages 41.0 ± 11.1 years) and 52,714 women (39.5 ± 11.6 years). C-PP was calculated for each sex by a multiple regression analysis including B-PP, age, height and risk factors, and a method validated beforehand in a subgroup of 834 subjects. During the 12 years of follow-up, 3,028 men and 969 women died.

Results

In the total population, the adjusted hazard ratios (HR) (95% confidence interval [CI]) of B/C-PP ratio were: 1) for all-cause mortality: men, HR: 1.51 (95% CI: 1.47 to 1.56), women; HR: 2.46 (95% CI: 2.27 to 2.67) (p < 0.0001); and 2) for CV mortality: men, HR 1.81 (95% CI: 1.70 to 1.93); women, HR: 4.46 (95% CI: 3.66 to 5.45) (p < 0.0001). The B/C-PP impact on mortality did not significantly increase from younger men to those ≥55 years of age, from: HR: 1.44 (95% CI: 1.31 to 1.58) to HR 1.65 (95% CI: 1.48 to 1.84), but increased significantly with age in women: HR: 3.19 (95% CI: 2.08 to 4.89) versus HR: 5.60 (95% CI: 4.17 to 7.50) (p < 0.01). Thus, the mortality impact of B/C-PP ratio was 3-fold higher in women than in men ≥55 years old.

Conclusions

PP amplification is highly predictive of differences in CV risk between men and women. In post-menopausal women, the attenuation of PP amplification, mainly related to increased aortic stiffness, contributes to the significant increase in CV risk.

Key Words

cardiovascular risk
sex
hypertension
pulse pressure
pulse pressure amplification

Abbreviations and Acronyms

B/C
brachial/carotid
BP
blood pressure
B-PP
brachial pulse pressure
CI
confidence interval
C-PP
carotid pulse pressure
CV
cardiovascular
DBP
diastolic blood pressure
HR
hazard ratio
MAP
mean arterial pressure
MHT
menopausal hormonal therapy
PP
pulse pressure
SBP
systolic blood pressure

Cited by (0)

This study was made possible with the help of the Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAMTS, Paris, France) and the Caisse Primaire d'Assurance Maladie de Paris (CPAM-Paris, France). This study was partly funded by INSERM (Institut de la Santé et de la Recherche Médicale).

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.