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Age and Sex Differences in the Contribution of Mean Arterial Pressure to Pulse Pressure Before Middle Age

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Abstract

Introduction

A lower ability to buffer pulse pressure (PP) in the face of increasing mean arterial pressure (MAP) may underlie the disproportionate increase in systolic blood pressure (SBP) in women from young adulthood through middle-aged relative to men.

Aim

To evaluate the contribution of MAP to the change in PP and pressure wave contour in men and women from young adulthood to middle age.

Methods

Central pressure waveform was obtained from radial artery applanation tonometry in 312 hypertensive patients between 16 to 49 years (134 women, mean age 35 ± 9 years), 185 of whom were on antihypertensive treatment.

Results

Higher MAP levels (≥ 100 mmHg) were significantly associated with higher brachial and central SBP (P < 0.001), PP (P < 0.001), incident wave (P = 0.005), AP (P < 0.001), and PWV (P < 0.001) compared to lower MAP levels. The relationship between MAP and brachial PP (P < 0.001), central PP (P < 0.001), incident wave (P < 0.001), and AP (P < 0.01), but not PWV, strengthens with age. The age-related increase in the contribution of MAP to brachial PP (P < 0.001), central PP (P < 0.001), and incident wave (P < 0.001) was more prominent in women than in men beginning in the fourth decade. In multiple regression analyses, MAP remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of age, heart rate, and antihypertensive treatment. In turn, age remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of MAP, heart rate, and antihypertensive treatment.

Conclusions

Women of reproductive age showed a steeper increase in PP with increasing MAP, despite comparable increases in arterial stiffness in both sexes. The difference was driven by a greater contribution of MAP to the forward component of the pressure wave in women.

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Data availability

The data that support the findings of this study are available from the corresponding author, [JA], upon request.

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Authors and Affiliations

  1. Sección Hipertensión Arterial, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199, Buenos Aires, Argentina

    José Alfie, Lucas S. Aparicio & Carlos R. Galarza

  2. Departamento de Investigación, Area de investigación no patrocinada, Secretaria de investigación, Universidad del Hospital Italiano, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199, Buenos Aires, Argentina

    María L. Posadas-Martinez

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  1. José Alfie
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  2. María L. Posadas-Martinez
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  3. Lucas S. Aparicio
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  4. Carlos R. Galarza
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Correspondence to José Alfie.

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Alfie, J., Posadas-Martinez, M.L., Aparicio, L.S. et al. Age and Sex Differences in the Contribution of Mean Arterial Pressure to Pulse Pressure Before Middle Age. High Blood Press Cardiovasc Prev (2024). https://doi.org/10.1007/s40292-024-00644-2

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