Pulse pressure and subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis

Ginger J. Winston, Walter Palmas, Joao Lima, Joseph F. Polak, Alain G. Bertoni, Gregory Burke, John Eng, Rebecca F Gottesman, Steven Shea

Research output: Contribution to journalArticle

Abstract

Background Brachial pulse pressure (PP) has been found to be associated with markers of subclinical cardiovascular disease, including carotid intima-media thickness and left-ventricular mass index (LVMI), but it is unclear whether these associations are independent of traditional cardiovascular risk factors and of the steady, nonpulsatile component of blood pressure (BP). Moreover, it is unknown whether these associations are modified by gender, age, or race/ethnicity. Methods We used multivariate linear regression models to assess the relationship between brachial PP and three markers of subclinical cardiovascular disease (CVD) (common carotid intima-media thickness (CC-IMT), internal carotid intima-media thickness (IC-IMT), and LVMI) in four race/ethnic groups in the Multi-Ethnic Study of Atherosclerosis. The models were adjusted for traditional Framingham risk factors (age, low-density lipoprotein- cholesterol, high-density lipoprotein-cholesterol, diabetes, smoking status), use of lipid-lowering medication, use of antihypertensive medication, study site, and mean arterial pressure (MAP).RESULTSThe assessment was done on 6,776 participants (2,612 non-Hispanic white, 1,870 African-American, 1,494 Hispanic, and 800 Chinese persons). The associations between brachial PP and CC-IMT, IC-IMT, and LVMI were significant in fully adjusted models. The three subclinical markers also showed significant interactions with gender (P <0.0001), with stronger interactions in men. There was an interaction with age for LVMI (P = 0.004) and IC-IMT (P = 0.008). Race/ethnicity modified the association of PP with CC-IMT. Conclusions Brachial PP was independently associated with subclinical CVD after adjustment for cardiovascular risk factors and mean arterial pressure (MAP). The strength of the association differed significantly for strata of gender, age, and race/ethnicity.

Original languageEnglish (US)
Pages (from-to)636-642
Number of pages7
JournalAmerican Journal of Hypertension
Volume26
Issue number5
DOIs
StatePublished - May 2013

Fingerprint

Carotid Intima-Media Thickness
Atherosclerosis
Cardiovascular Diseases
Blood Pressure
Arm
Linear Models
Arterial Pressure
Hispanic Americans
Ethnic Groups
African Americans
LDL Cholesterol
HDL Cholesterol
Antihypertensive Agents
Smoking
Lipids

Keywords

  • aging
  • arterial stiffness
  • blood pressure
  • carotid intima-media thickness
  • hypertension
  • left ventricular mass index
  • pulse pressare
  • subclinical cardiovascular disease

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Pulse pressure and subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis. / Winston, Ginger J.; Palmas, Walter; Lima, Joao; Polak, Joseph F.; Bertoni, Alain G.; Burke, Gregory; Eng, John; Gottesman, Rebecca F; Shea, Steven.

In: American Journal of Hypertension, Vol. 26, No. 5, 05.2013, p. 636-642.

Research output: Contribution to journalArticle

Winston, Ginger J. ; Palmas, Walter ; Lima, Joao ; Polak, Joseph F. ; Bertoni, Alain G. ; Burke, Gregory ; Eng, John ; Gottesman, Rebecca F ; Shea, Steven. / Pulse pressure and subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis. In: American Journal of Hypertension. 2013 ; Vol. 26, No. 5. pp. 636-642.
@article{0a924a6da37844fdb6adce6067bb0fb4,
title = "Pulse pressure and subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis",
abstract = "Background Brachial pulse pressure (PP) has been found to be associated with markers of subclinical cardiovascular disease, including carotid intima-media thickness and left-ventricular mass index (LVMI), but it is unclear whether these associations are independent of traditional cardiovascular risk factors and of the steady, nonpulsatile component of blood pressure (BP). Moreover, it is unknown whether these associations are modified by gender, age, or race/ethnicity. Methods We used multivariate linear regression models to assess the relationship between brachial PP and three markers of subclinical cardiovascular disease (CVD) (common carotid intima-media thickness (CC-IMT), internal carotid intima-media thickness (IC-IMT), and LVMI) in four race/ethnic groups in the Multi-Ethnic Study of Atherosclerosis. The models were adjusted for traditional Framingham risk factors (age, low-density lipoprotein- cholesterol, high-density lipoprotein-cholesterol, diabetes, smoking status), use of lipid-lowering medication, use of antihypertensive medication, study site, and mean arterial pressure (MAP).RESULTSThe assessment was done on 6,776 participants (2,612 non-Hispanic white, 1,870 African-American, 1,494 Hispanic, and 800 Chinese persons). The associations between brachial PP and CC-IMT, IC-IMT, and LVMI were significant in fully adjusted models. The three subclinical markers also showed significant interactions with gender (P <0.0001), with stronger interactions in men. There was an interaction with age for LVMI (P = 0.004) and IC-IMT (P = 0.008). Race/ethnicity modified the association of PP with CC-IMT. Conclusions Brachial PP was independently associated with subclinical CVD after adjustment for cardiovascular risk factors and mean arterial pressure (MAP). The strength of the association differed significantly for strata of gender, age, and race/ethnicity.",
keywords = "aging, arterial stiffness, blood pressure, carotid intima-media thickness, hypertension, left ventricular mass index, pulse pressare, subclinical cardiovascular disease",
author = "Winston, {Ginger J.} and Walter Palmas and Joao Lima and Polak, {Joseph F.} and Bertoni, {Alain G.} and Gregory Burke and John Eng and Gottesman, {Rebecca F} and Steven Shea",
year = "2013",
month = "5",
doi = "10.1093/ajh/hps092",
language = "English (US)",
volume = "26",
pages = "636--642",
journal = "Journal of clinical hypertension",
issn = "0895-7061",
publisher = "Oxford University Press",
number = "5",

}

TY - JOUR

T1 - Pulse pressure and subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis

AU - Winston, Ginger J.

AU - Palmas, Walter

AU - Lima, Joao

AU - Polak, Joseph F.

AU - Bertoni, Alain G.

AU - Burke, Gregory

AU - Eng, John

AU - Gottesman, Rebecca F

AU - Shea, Steven

PY - 2013/5

Y1 - 2013/5

N2 - Background Brachial pulse pressure (PP) has been found to be associated with markers of subclinical cardiovascular disease, including carotid intima-media thickness and left-ventricular mass index (LVMI), but it is unclear whether these associations are independent of traditional cardiovascular risk factors and of the steady, nonpulsatile component of blood pressure (BP). Moreover, it is unknown whether these associations are modified by gender, age, or race/ethnicity. Methods We used multivariate linear regression models to assess the relationship between brachial PP and three markers of subclinical cardiovascular disease (CVD) (common carotid intima-media thickness (CC-IMT), internal carotid intima-media thickness (IC-IMT), and LVMI) in four race/ethnic groups in the Multi-Ethnic Study of Atherosclerosis. The models were adjusted for traditional Framingham risk factors (age, low-density lipoprotein- cholesterol, high-density lipoprotein-cholesterol, diabetes, smoking status), use of lipid-lowering medication, use of antihypertensive medication, study site, and mean arterial pressure (MAP).RESULTSThe assessment was done on 6,776 participants (2,612 non-Hispanic white, 1,870 African-American, 1,494 Hispanic, and 800 Chinese persons). The associations between brachial PP and CC-IMT, IC-IMT, and LVMI were significant in fully adjusted models. The three subclinical markers also showed significant interactions with gender (P <0.0001), with stronger interactions in men. There was an interaction with age for LVMI (P = 0.004) and IC-IMT (P = 0.008). Race/ethnicity modified the association of PP with CC-IMT. Conclusions Brachial PP was independently associated with subclinical CVD after adjustment for cardiovascular risk factors and mean arterial pressure (MAP). The strength of the association differed significantly for strata of gender, age, and race/ethnicity.

AB - Background Brachial pulse pressure (PP) has been found to be associated with markers of subclinical cardiovascular disease, including carotid intima-media thickness and left-ventricular mass index (LVMI), but it is unclear whether these associations are independent of traditional cardiovascular risk factors and of the steady, nonpulsatile component of blood pressure (BP). Moreover, it is unknown whether these associations are modified by gender, age, or race/ethnicity. Methods We used multivariate linear regression models to assess the relationship between brachial PP and three markers of subclinical cardiovascular disease (CVD) (common carotid intima-media thickness (CC-IMT), internal carotid intima-media thickness (IC-IMT), and LVMI) in four race/ethnic groups in the Multi-Ethnic Study of Atherosclerosis. The models were adjusted for traditional Framingham risk factors (age, low-density lipoprotein- cholesterol, high-density lipoprotein-cholesterol, diabetes, smoking status), use of lipid-lowering medication, use of antihypertensive medication, study site, and mean arterial pressure (MAP).RESULTSThe assessment was done on 6,776 participants (2,612 non-Hispanic white, 1,870 African-American, 1,494 Hispanic, and 800 Chinese persons). The associations between brachial PP and CC-IMT, IC-IMT, and LVMI were significant in fully adjusted models. The three subclinical markers also showed significant interactions with gender (P <0.0001), with stronger interactions in men. There was an interaction with age for LVMI (P = 0.004) and IC-IMT (P = 0.008). Race/ethnicity modified the association of PP with CC-IMT. Conclusions Brachial PP was independently associated with subclinical CVD after adjustment for cardiovascular risk factors and mean arterial pressure (MAP). The strength of the association differed significantly for strata of gender, age, and race/ethnicity.

KW - aging

KW - arterial stiffness

KW - blood pressure

KW - carotid intima-media thickness

KW - hypertension

KW - left ventricular mass index

KW - pulse pressare

KW - subclinical cardiovascular disease

UR - http://www.scopus.com/inward/record.url?scp=84876566732&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84876566732&partnerID=8YFLogxK

U2 - 10.1093/ajh/hps092

DO - 10.1093/ajh/hps092

M3 - Article

C2 - 23388832

AN - SCOPUS:84876566732

VL - 26

SP - 636

EP - 642

JO - Journal of clinical hypertension

JF - Journal of clinical hypertension

SN - 0895-7061

IS - 5

ER -