Higher pressure reflects aortic stiffness and might be a modifiable risk factor.
Increased pulse pressure leads to greater pulsatile load on the heart, ventricular hypertrophy, and increased atrial dimensions. The latter may lead to electrical remodeling in the atrium and to the onset of atrial fibrillation (AF), which affects more than 2.3 million adults in the U.S. To assess the association between pulse pressure and AF, the authors conducted a prospective observational study of 5331 Framingham Heart Study participants (median age, 57 years; 53% women) who were followed for a mean of 16 years, ending in 2004.
AF occurred in 13.1% of patients at a median of 12 years after initial pulse pressure measurement. The 20-year cumulative AF incidence rate was 5.6% in patients with initial pulse pressure <40 mm Hg (25th percentile) and 23.3% in those with pulse pressure >61 mm Hg (75th percentile). In analyses adjusting for age, sex, mean arterial pressure, and clinical risk factors for AF, the hazard ratio for developing AF was 1.26 per 20-mm Hg increase in pulse pressure.
Comment: The lifetime risk for AF is approximately 25% for men and women, and AF increases the risk for stroke and mortality. These data suggest that increased pulse pressure, a reflection of aortic stiffness, is a modifiable risk factor for AF. Drugs that induce renin-angiotensin blockade might be effective in this regard.
— John A. Marx, MD, FAAEM, FACEP
Published in Journal Watch Emergency Medicine March 9, 2007
Mitchell GF et al. Pulse pressure and risk of new-onset atrial fibrillation. JAMA 2007 Feb 21; 297:709-15.