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Claudia U. Chae, MD; Marc A. Pfeffer, MD, PhD; Robert J. Glynn, ScD; Gary F. Mitchell, MD; James O. Taylor, MD; Charles H. Hennekens, MD, DrPH

JAMA. 1999;281:634-643.

Context  Arterial stiffness increases with age. Thus, pulse pressure, an index of arterial stiffening, may predict congestive heart failure (CHF) in the elderly.

Objective  To study prospectively the association between pulse pressure and risk of CHF.

Design  Prospective cohort study.

Setting  The community-based East Boston Senior Health Project, East Boston, Mass.

Patients  A total of 1621 men and women (mean [SD] age, 77.9 [5.0] years) free of CHF who had blood pressure measurements taken in 1988-1989 and were followed up for 3.8 years.

Main Outcome Measure  Incidence of CHF as ascertained by hospital discharge diagnosis (n=208) and death certificates (n=13).

Results  After controlling for age, sex, mean arterial pressure, history of coronary heart disease, diabetes mellitus, atrial fibrillation, valvular heart disease, and antihypertensive medication use, pulse pressure was an independent predictor of CHF. For each 10-mm Hg elevation in pulse pressure, there was a 14% increase in risk of CHF (95% confidence interval, 1.05-1.24; P=.003). Those in the highest tertile of pulse pressure (>67 mm Hg) had a 55% increased risk of CHF (P=.02) compared with those in the lowest (<54 mm Hg). Pulse pressure was more predictive than systolic blood pressure alone and was independent of diastolic blood pressure.

Conclusion  Pulse pressure, an easily measurable correlate of pulsatile hemodynamic load, is an independent predictor of risk of CHF in this elderly cohort.

Author Affiliations: Division of Preventive Medicine (Drs Chae, Glynn, and Hennekens) and the Cardiovascular Division (Drs Pfeffer and Mitchell), Department of Medicine, Brigham and Women's Hospital, the Cardiology Division, Department of Medicine, Massachusetts General Hospital (Dr Chae); the Department of Ambulatory Care and Prevention, Harvard Medical School (Dr Hennekens), the Departments of Biostatistics (Dr Glynn) and Epidemiology (Dr Hennekens), Harvard School of Public Health, Boston, Mass; and the East Boston Neighborhood Health Center, East Boston, Mass (Drs Taylor and Hennekens).

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