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Is the predictive power of a low-pulse pressure independent of peak oxygen uptake in advanced chronic heart failure?

Journal of Human Hypertension volume 22, pages 57–59 (2008)Cite this article

A pulse pressure (PP) below 35–40 mm Hg has been shown to carry a worse prognosis in patients with chronic heart failure (CHF), but its non-dependence on peak oxygen uptake, which is a major if not the major prognostic factor in these patients, has not been studied. We assessed whether PP adds prognostic precision to peak oxygen uptake in 284 patients with advanced CHF, in whom blood pressure (BP) was measured at rest and who performed a graded symptom-limited bicycle exercise test with respiratory gas analysis. The results confirm that a low PP rather than a high PP predicts cardiovascular (CV) mortality in patients with CHF and that PP adds prognostic value to peak oxygen uptake, which is the strongest predictor of outcome.

Pulse pressure (PP) is determined by vascular stiffness and by left ventricular (LV) ejection rate or stroke volume. In the population at large and in patients with hypertension without clinical evidence of LV dysfunction, PP mainly reflects vascular stiffness, which explains the association of a high PP with a worse prognosis.1, 2, 3, 4 By contrast, recent studies have shown that a low PP carries a worse prognosis in patients with advanced chronic heart failure (CHF)5, 6and decompensated heart failure,7 which is attributed to the fact that the impaired LV function has become the major determinant of PP. However, peak oxygen uptake (VO2peak), which is a major if not the major prognostic factor in CHF8, 9 was not considered in these studies. Our aim was therefore to analyse whether PP adds prognostic precision to VO2 peak in patients with advanced CHF, who were referred to our centre for assessment of their suitability for heart transplantation (HTX) between May 1991 and December 1996 and who performed a graded symptom-limited bicycle exercise test with measurement of respiratory gas analysis, including VO2 peak.9 Blood pressure (BP) was measured by the auscultatory technique using the STBP-78 device (Colin, Komaki, Japan) or directly by trained investigators, at rest in the sitting position before the exercise test. PP was calculated as the difference between systolic and diastolic BP, and mean BP as diastolic BP plus one-third of PP. Information on vital status and cause of death, starting on the date of the exercise test till the end of 1997, was obtained in all patients from hospital files and the patient's physician(s).

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Authors and Affiliations

  1. Department of Cardiovascular Diseases, Faculty of Medicine, Hypertension and Cardiovascular Rehabilitation Unit, University of Leuven, Leuven, Belgium

    R H Fagard & K Pardaens

  2. Department of Cardiovascular Diseases, Faculty of Medicine, Cardiology Unit, University of Leuven, Leuven, Belgium

    J Vanhaecke

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  1. R H Fagard
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  2. K Pardaens
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  3. J Vanhaecke
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Correspondence to R H Fagard.

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Fagard, R., Pardaens, K. & Vanhaecke, J. Is the predictive power of a low-pulse pressure independent of peak oxygen uptake in advanced chronic heart failure?. J Hum Hypertens 22, 57–59 (2008). https://doi.org/10.1038/sj.jhh.1002258

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