Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure

Abstract

Major adverse cardiovascular events are closely associated with 24-hour blood pressure (BP). We determined outcome-driven thresholds for 24-hour mean arterial pressure (MAP), a BP index estimated by oscillometric devices. We assessed the association of major adverse cardiovascular events with 24-hour MAP, systolic BP (SBP), and diastolic BP (DBP) in a population-based cohort (n=11 596). Statistics included multivariable Cox regression and the generalized R 2 statistic to test model fit. Baseline office and 24-hour MAP averaged 97.4 and 90.4 mm Hg. Over 13.6 years (median), 2034 major adverse cardiovascular events occurred. Twenty-four-hour MAP levels of <90 (normotension, n=6183), 90 to <92 (elevated MAP, n=909), 92 to <96 (stage-1 hypertension, n=1544), and ≥96 (stage-2 hypertension, n=2960) mm Hg yielded equivalent 10-year major adverse cardiovascular events risks as office MAP categorized using 2017 American thresholds for office SBP and DBP. Compared with 24-hour MAP normotension, hazard ratios were 0.96 (95% CI, 0.80–1.16), 1.32 (1.15–1.51), and 1.77 (1.59–1.97), for elevated and stage-1 and stage-2 hypertensive MAP. On top of 24-hour MAP, higher 24-hour SBP increased, whereas higher 24-hour DBP attenuated risk ( P <0.001). Considering the 24-hour measurements, R 2 statistics were similar for SBP (1.34) and MAP (1.28), lower for DBP than for MAP (0.47), and reduced to null, if the base model included SBP and DBP; if the ambulatory BP indexes were dichotomized according to the 2017 American guideline and the proposed 92 mm Hg for MAP, the R 2 values were 0.71, 0.89, 0.32, and 0.10, respectively. In conclusion, the clinical application of 24-hour MAP thresholds in conjunction with SBP and DBP refines risk estimates.

Clinical Significance of Mean and Pulse Pressure in Patients With Heart Failure With Preserved Ejection Fraction

“…Although several previous studies showed that both MAP 5 – 7 and pulse pressure 6 , 8 – 11 predict adverse health outcomes in populations, in patients with cardiovascular or renal disease, and in critically ill patients, several other studies indicated that pulse pressure was associated with the risk of cardiovascular disease, beyond MAP. 6 , 12 – 14 However, no previous studies systematically compared the effects of MAP and pulse pressure on adverse health outcomes in patients with heart failure with preserved ejection fraction (HFpEF).…”

Gut and airway microbiota and their role in COVID-19 infection and pathogenesis: a scoping review

“…All papers studied COVID-19 cases retrospectively and there was lack of longitudinal data to determine microbiota composition at baseline since this is not routinely assessed in the management of COVID-19 patients. More animal studies in the future may give us further insight on the progression of the microbiome alteration during the whole course of disease [ 71 ]. Another limitation is that 9 out of 10 gut microbiota studies came from either China or Hong Kong, while subjects from the airway microbiota studies were recruited in 6 different countries.…”

The International Database of Central Arterial Properties for Risk Stratification: Research Objectives and Baseline Characteristics of Participants

“…These devices derive mean arterial pressure from the envelope drawn around the maximal pressure oscillations in the brachial cuff, an argument in favor of the calibration involving mean arterial pressure, and extrapolate systolic and diastolic blood pressure by the embedded proprietary software. 66 , 67 Alternatively, mean arterial pressure may be calculated from the brachial cuff blood pressure as diastolic plus 33% or 40% of pulse pressure. 39 …”