Outcome-Driven Thresholds for Ambulatory Pulse Pressure in 9938 Participants Recruited From 11 Populations

Yu-Mei Gu, Lutgarde Thijs, Yan Li, Kei Asayama, Jose Boggia, Tine W. Hansen, Yan-Ping Liu, Takayoshi Ohkubo, Krishna Bjorklund-Bodegard, Jorgen Jeppesen, Eamon Dolan, Christian Torp-Pedersen, Tatiana Kuznetsova, Katarzyna Stolarz-Skrzypek, Valerie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars Lind, Edgardo SandoyaKalina Kawecka-Jaszcz, Yutaka Imai, Luis J. Mena, Jiguang Wang, Eoin O'Brien, Peter Verhamme, Jan Filipovsky, Gladys E. Maestre, Jan A. Staessen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Evidence-based thresholds for risk stratification based on pulse pressure (PP) are currently unavailable. To derive outcome-driven thresholds for the 24-hour ambulatory PP, we analyzed 9938 participants randomly recruited from 11 populations (47.3% women). After age stratification (= 60 years) and using average risk as reference, we computed multivariable-adjusted hazard ratios (IIRs) to assess risk by tenths of the PP distribution or risk associated with stepwise increasing (+1 mm Hg) PP levels. All adjustments included mean arterial pressure. Among 6028 younger participants (68 853 person-years), the risk of cardiovascular (HR, 1.58; P=0.011) or cardiac (HR, 1.52; P=0.056) events increased only in the top PP tenth (mean, 60.6 mm Hg). Using stepwise increasing PP levels, the lower boundary of the 95% confidence interval of the successive thresholds did not cross unity. Among 3910 older participants (39 923 person-years), risk increased (P
Original languageEnglish
Pages (from-to)229–237
Issue number2
Publication statusPublished - Feb 2014


  • ambulatory blood pressure
  • epidemiology
  • population science
  • pulse pressure

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