Reference frame for home pulse pressure based on cardiovascular risk in 6470 subjects from 5 populations

The absence of an outcome-driven reference frame for self-measured pulse pressure (PP) limits its clinical applicability. In an attempt to derive an operational threshold for self-measured PP, we analyzed 6470 participants (mean age 59.3 years; 56.9% women; 22.5% on antihypertensive treatment) from 5 general population cohorts included in the International Database on HOme blood pressure in relation to Cardiovascular Outcome. During 8.3 years of follow-up (median), 294 cardiovascular deaths, 393 strokes and 336 cardiac events occurred. In 3285 younger subjects (= 60 years) PP predicted total and cardiovascular mortality (P = 76 mm Hg) versus the average risk in whole population were 1.41 (95% confidence interval, 1.09-1.81; P = 0.0081) for all-cause mortality, 1.62 (1.11-2.35; P = 0.012) for cardiovascular mortality and 1.31 (1.00-1.70; P = 0.047) for all fatal and nonfatal cardiovascular end points combined. The low number of events precluded an analysis by tenths of the PP distribution in younger participants. In conclusion, a home PP of >= 76 mm Hg predicted cardiovascular outcomes in the elderly with the exception of stroke, whereas in younger subjects no threshold could be established.