P5467Gender related differences in the clinical significance of elevated pulse pressure in the young. Results from the HARVEST study
Authors: Saladini F , Mos L , Fania C , Mazzer A , Garavelli G , Zanata G , Spinella P , Palatini P 
Published: October 2019

Abstract

Background
Elevated pulse pressure (PP) is a well known cardiovascular risk factor in the elderly. Whether PP is a harbinger of adverse outcome also in young individuals is still a matter of debate. Moreover, the prognostic significance of elevated PP in the young seems to differ according to gender. Recently, we showed that PP was a predictor of adverse outcome only in young women while in men PP even had a protective effect.

Aim
The aim of the present study was to identify clinical, metabolic and haemodynamic characteristics associated with high PP in young hypertensive adults and to investigate whether these associations differed according to gender.

Methods
We investigated 1207 young stage I hypertensives (878 males) from the HARVEST Study, a long-term observational study involving 17 centres in the North-East of Italy. Mean age was 33.1±8.5 years and BP 145.5±10.6/93.5±5.7 mmHg. At the baseline patients underwent office and ambulatory blood pressure measurements and biochemical analyses and were followed at 6-month intervals until they developed hypertension requiring pharmacological treatment. For the analysis patients were divided into PP tertiles. All comparisons between males and females were tested with age-adjusted two-way ANCOVA using PP and sex as predictors.

Results
PP was 52.8±11.4 mmHg in men and 49.4±9.4 mmHg in women (p<0.001). Metabolic data did not differ between the two genders. Echocardiographic stroke volume was higher in men than women (82.1±15.7 ml vs 70.8±16.4 ml, p<0.001). No between-sex difference was found for peripheral resistance. Twenty-four-hour urinary norepinephrine/creatinine was higher in women than men (68.2±59.6 vs 54.4±66.5 mcg/mg, p=0.023), whereas no difference was found for epinephrine. Stratification by PP tertile showed that men in the top tertile were younger and had lower BMI than those in the bottom tertile (p<0.001 and p=0.002), while the opposite trend was found for women (p<0.001 and p=0.002) with a significant PP-sex interaction (p<0.001 for both). Heart rate and systolic white coat effect progressively increased across PP tertiles in both genders (p<0.001 for both). Glucose and triglycerides increased with increasing PP among women while the opposite was found for men, with a significant trend for glucose (p=0.025). At the end of follow-up (mean 7.9 years) females in the top PP tertile presented higher systolic BP (p=0.004), diastolic BP (p=0.071) and heart rate (<0.001), compared to males of the corresponding tertile.

Conclusions
Young hypertensive women were characterized by increased sympathetic activity whereas men showed a hyperkinetic state. High PP was associated with greater BMI and worse metabolic profile in women, and with better metabolic data in men. This different pathogenetic background may account for the worse time-course of isolated systolic hypertension in women compared to men shown by previous studies.

Acknowledgement/Funding
None