Is pulse pressure a predictor of cardiovascular complications in a frail elderly nursing home population?

Background and aims: Previous studies have focused on systolic blood pressure (SBP), diastolic pressure (DBP), and more recently pulse pressure (PP) as risk factors for adverse cardiovascular (CV) end-points in elderly people. However, the relation between these pressures and CV complications in the frail nursing home population has not been well studied. The aims of this project are to determine the value of PP in predicting CV complications in a nursing home population, and to compare its predictive value with SBP, DBP, and mean arterial pressure (MAP). Methods: This study is a retrospective 2-year review of the medical charts of 248 residents of the Hebrew Rehabilitation Center for the Aged, a long-term care facility in Boston, MA, USA. During the review process, data were collected about post medical history and new onset CV events, in addition to blood pressure and medication use. Results: The results showed, with 95% confidence, that within a 2-year period, the odds ratio for the occurrence of the selected CV outcomes (myocardial infarction, congestive heart failure, angina, stroke, renal failure, syncope, death) included 1.0 for PP, SBP, DBP, MAP, and changes in these values. After adjusting for medication use, pulse pressure was still not an independent risk factor for CV complications. Conclusions: PP, SBP, DBP or MAP cannot serve as predictors of CV outcomes in the nursing home population. The presence of multiple medical problems in this frail population may have resulted in CV morbidity and mortality, independent of blood pressure effects. (C) 2004, Editrice Kurtis.