Antihypertensive Treatment Alters the Predictive S

Authors: Greenberg James

Publish Date: 2005/08/01

Volume: 18, Issue: 8, Pages: 1033-1039

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Abstract

James Greenberg Antihypertensive Treatment Alters the Predictive Strength of Pulse Pressure and Other Blood Pressure Measures American Journal of Hypertension Volume 18 Issue 8 August 2005 Pages 1033–1039 https//doiorg/101016/jamjhyper200503735Data from the First National Health and Nutrition Examination Survey Epidemiologic Follow Up Study were used to conduct Cox regression analyses There were 487 cardiovascular disease CVD and 348 coronary heart disease CHD deaths during an 86year followup among 2939 hypertensive subjects 33 to 87 years of age A correction was made for the regression–dilution biasPulse pressure PP was a significant single predictor for treated but not untreated hypertensive subjects The hazard ratio 95 confidence interval for CVD mortality for an 10–mm Hg increment of PP was 116 95 CI = 108 to 125 for treated hypertensive subjects and 112 95 CI = 099 to 126 for untreated hypertensive subjects Also PP was a significant predictor after accounting for the effects of mean arterial pressure MAP but only in treated hypertensive subjects The pattern was opposite for diastolic pressure DBP Analysis of antihypertensive treatment trends suggests that clinicians focused treatment more on hypertensive subjects with elevated DBP and low PP during the 1970s and early 1980s thereby causing DBP to become a weak predictor and PP a strong predictor among treated hypertensive subjects This tendency was particularly noticeable at higher ages For instance among hypertensive subjects ≥65 years of age during this period the percentage who were treated increased from 76 to 450 and the ratio of subjects with isolated systolic hypertension to those with isolated diastolic hypertension among those who were untreated increased from 112 to 451There have been conflicting reports about the relative predictive strength of auscultatory office brachial pulse pressure PP Some investigators have concluded that PP is a better predictor than diastolic blood pressure DBP1–7 systolic blood pressure SBP3–5 and mean arterial pressure MAP3 Others have found the opposite89Part of the conflict may be caused by different types of antihypertensive treatment among subjects in these previous studies because antihypertensive treatment itself could affect the predictive strength of PP For instance recommendations from the Joint National Committee on Prevention Detection Evaluation and Treatment of High Blood Pressure JNC during the 1970s and 1980s focused primarily on elevated DBP1011 Antihypertensive treatment focused on elevated DBP could decrease DBP more than SBP among hypertensive subjects in prospective followup studies This treatment strategy would tend to reduce elevated DBP more than elevated SBP and hence increase PP among hypertensive subjects and therefore increase the predictive strength of PPThe purpose of the present analysis was to assess the effects of antihypertensive treatment in the 1970s and 1980s on the predictive strength of different auscultatory office brachial blood pressure BP measures among hypertensive subjects in the First National Health and Nutritional Examination Survey NHANES I Epidemiologic Follow up Study NHEFSThe NHEFS is a longitudinal study of the persons 25 to 74 years of age N = 14407 examined in 1971–1975 in NHANES I a probability sample survey of the noninstitutionalized civilian population in the United States12 Four followup surveys have been completed in NHEFS in 1982–1984 1986 1987 and 1992 The baseline data used in the present study were obtained by means of medical histories and examinations and by survey questionnaires administered at the 1971–1975 survey and at the first followup survey in 1982–198413

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