BANTAO Journal 2 (2): p 10; 2004 _______________________________ Correspondence to: Dijana Jovanovic, Institute of Urology and Nephrology, Clinic of Nephrology, Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia and Montenegro, Tel: +381 11 2686-740, E-mail: di- janaj@Eunet.yu Pulse Pressure and Risk of Cardiovascular Events and Mortality in Patients on Haemodialysis Dijana Jovanovic, Milan Stosovic, Svetlana Pejanovic, Vladimir Ostric, Vidosava Nesic Institute of Urology and Nephrology, Clinic of Nephrology, Clinical Centre of Serbia, Belgrade Abstract Over the years, diastolic- (DBP), systolic- (SBP) and pulse (PP) pressures have successively been entered into the equation for cardiovascular (CVS) risk. In recent studies PP has been shown as a risk factor for CVS events or total mortality. In this study we analysed 94 patients (52 men and 42 women) of average age 57.84 ± 11.62 years, who were on chronic haemodialysis in our Centre during a period of 7 years. Comorbid conditions were indexed using IDS (index of disease sever- ity) and cardiovascular components of this index were also included in the analysis [ischaemic heart disease, congestive heart failure, arrhythmia, other cardiovascular diseases (OTH) mainly dependent of left ventricular hypertrophy (LVH), hypertension (HTA) and total CVS morbidity]. We analysed the correlation between average values of blood pressure components: diastolic- , systolic-, mean arterial- (MAP) and pulse pressure and these individual comorbid CVS components as well as total CVS mor- bidity, index of disease severity (IDS), haemoglobin (Hb), serum calcium (Ca), phosphate (PO 4 ), albumin, body mass index (BMI), Kt/V (Daurgidas), age and mortality. The analysis revealed: significant positive correlation between PP (0.021) and SBP (0.012) and total CVS morbidity, PP (0.009) and SBP (0.051) and OTH with LVH, PP (0.022) and SBP (0.041) and total IDS, all blood pressure components and HTA, all blood pressure components and serum PO4; significant negative correlation between PP (0.049) and Hb, MAP (0.029) and age. Cox proportional hazard model did not reveal PP, SBP, DBP and MAP as mortality risk factors in this group of haemodialysis patients. So, we can conclude that PP was a good predictor of total CVS morbidity, LVH, total IDS and anaemia (Hb), but it was not a predictor of mortality in our analysed patients. Introduction Over the years, diastolic-, systolic-, median- and pulse pres- sures have successively been entered into the equation for cardiovascular (CVS) risk. First it was diastolic blood pres- sure (DBP) (1), then systolic blood pressure (SBP) and mean arterial pressure (MAP) (2-4). From this contraposi- tion between systolic and diastolic blood pressure the notion of pulse pressure (PP) as a risk factor appeared as a logical consequence, the more so because it represents the most straightforward expression of pathological arterial wall ri- gidity (3-5). Blood pressure components and CVS risk were the object of many experimental, clinical and epidemiological studies, which analysed various groups of patients. From these stud- ies we can conclude that SBP and DBP are the best markers for CVS risk in the young, but PP is the best marker for CVS risk in the middle aged and elderly (6). Pulse pressure is a better marker for CVS morbidity than MAP (7). The aim of this study was to analyse the correlation between blood pressure components and CVS comorbid compo- nents, laboratory parameters, clinical parameters and mor- tality in patients on haemodialysis. Patients and methods The study included 94 patients (52 men and 42 women) aged between 23 and 84 years, who were on chronic haemodialysis in our Centre during a period of 7 years. Inclusion criteria: All patients in our Centre who were more than two years on haemodialysis on January 1 st 1996. It was a 7-year prospective single cohort study, which consisted of: two years of baseline measurements (1996-1997) and 5 years of follow-up (1998-2002). Comorbid conditions were indexed using the index of disease severity (IDS), as it was done in HEMO study as a part of the index of coexistent diseases (ICED), and cardiovascular components of this in- dex which were also included in the analysis, such as the following: hypertension (HTA) as comorbid condition, is- chaemic heart disease (IHD), congestive heart failure (CHF), arrhythmia (ARR), other cardiovascular diseases (OTH) mainly dependent on left ventricular hypertrophy (LVH) and total CVS morbidity (8). Example of indexing for hypertension: 0 – no hypertension; 1 – moderate hyper- tension without therapy; 2 – mild hypertension on anti- hypertensive therapy; 3 – severe hypertension on antihyper- tensive therapy. We analysed the correlation between aver- age values of blood pressure components: diastolic, sys- tolic-, mean arterial- and pulse pressures and individual co- morbid CVS components as well as total CVS morbidity, IDS, haemoglobin (Hb), serum calcium (Ca), phosphate (PO 4 ), albumin, body mass index (BMI), Kt/V (Daurgidas), age, mortality. Cox proportional hazard model was used for analysing blood pressure components as mortality risk fac- tors in haemodialysis patients.