Higher Pulse Pressure Is Associated With Increased Risk of Cardio-cerebrovascular Disease and All-Cause Mortality: A Korean National Cohort Study

BACKGROUND This study aimed to investigate the association of pulse pressure (PP) with the cardio-cerebrovascular disease (CCVD) risk and all-cause mortality according to blood pressure level using Korean national cohort data. METHODS This study was retrospectively designed and based on the Korean National Health Insurance Service-National Health Screening Cohort. Participants aged 40–69 years at baseline were categorized into normal, elevated, stage 1, and stage 2 groups according to blood pressure. Each group was further classified into 5 groups separated by 10-mm Hg increments in PP. The primary composite outcome was defined as CCVDs and all-cause mortality. Cox proportional hazards regression models were adopted after stepwise adjustment for confounders to investigate the composite outcome. RESULTS During the follow-up period (median follow-up period, 12.0 years), the primary composite outcome occurred in 18,444 (15.0%) of 122,783 men and 10,096 (11.4%) of 88,550 women. After complete adjustment for confounders, in the stage 1 hypertensive men, the hazard ratio (95% confidence intervals [CIs]) of the 31–40, 41–50, 51–60, and >60 mm Hg PP groups was 1.112 (1.013–1.221), 1.035 (0.942–1.137), 1.009 (0.907–1.123), and 1.324 (1.130–1.551) in comparison with the ≤30 mm Hg PP group. In the stage 2 hypertensive men, the HRs (95% CIs) were 1.069 (0.949–1.204), 1.059 (0.940–1.192), 1.123 (0.999–1.263), and 1.202 (1.061–1.358) compared to the ≤30 mm Hg PP group. However, these associations were not significant in women. CONCLUSIONS Hypertensive men with an increased PP have an increased risk of CCVDs and all-cause mortality.