Pulse Pressure and Coronary Atherosclerosis Progression in Postmenopausal Women

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 45; no. 1; pp. 53 - 57
• Main Authors: Nair, Girish V, Waters, David, Rogers, William, Kowalchuk, Glen J, Stuckey, Thomas D, Herrington, David M
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.01.2005; Hagerstown, MD Lippincott
• Subjects: Aged; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - drug effects; Cardiology. Vascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary Artery Disease - physiopathology; Disease Progression; Estrogen Replacement Therapy; Estrogens, Conjugated (USP) - pharmacology; Female; Follow-Up Studies; Hormone Replacement Therapy; Hormones. Endocrine system; Humans; Medical sciences; Medroxyprogesterone Acetate - pharmacology; Middle Aged; Pharmacology. Drug treatments; Postmenopause; Single-Blind Method; Vascular Resistance; Human; Hormone; Replacement therapy; Estrogen; Stenosis; Cardiovascular disease; Coronary arteriography; Progestagen; Vascular disease; Atherosclerosis; Postmenopause; pulse; Blood pressure; Stiffness; Progesterone; women
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/01.HYP.0000149599.99266.44

Pulse pressure, an index of large artery stiffness, has been associated with coronary events. However, mechanisms for this association remain unclear. In this study, we examined the relationship between pulse pressure and the progression of coronary atherosclerosis and the effects of hormone replacement therapy (HRT) on pulse pressure in postmenopausal women with angiographically confirmed coronary disease followed for 3.2 years in the Estrogen Replacement in Atherosclerosis (ERA) trial. In the ERA trial, 309 postmenopausal women (mean age 66±7 years) with coronary disease were randomized to estrogen, estrogen plus progestin, or placebo, and followed for 3.2 years. Ten standardized epicardial segments were measured for minimal diameter values at baseline and follow-up using quantitative coronary angiography. For this study, mixed-model analysis of covariance was used to(1) test the association between pulse pressure and change in mean minimum diameter (MMD) adjusted for baseline MMD and (2) the effect of HRT on follow-up pulse pressure. After adjustment for potential confounders, there was a significant graded increase in progression of coronary stenosis with increasing quartiles of baseline pulse pressure (P test for trend=0.0001). The progression rate in women with the highest quartile of baseline pulse pressure was 5-fold higher than in women in the lowest quartile (P<0.01). In postmenopausal women with coronary disease, increased levels of baseline pulse pressure are associated with subsequent progression of coronary atherosclerosis in postmenopausal women. HRT had no detectable effect on pulse pressure.