• Shijun Li, Salim Barywani, and Michael Fu.
• aSection of Cardiology, Department of Medicine, Sahlgrenska University Hospital, Östra Hospital, Gothenburg, Sweden bSection of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China.
• J. Hypertens. 2015 Feb 1; 33 (2): 279-86.

ObjectiveThe impact of lower pulse pressure (PP) on long-term all-cause mortality in the octogenarian patients with acute coronary syndrome (ACS) remains unknown. This study sought to reveal the prognostic power of lower PP in long-term all-cause mortality in the octogenarian ACS patients.MethodsThe current study included a total of 353 consecutive ACS patients aged at least 80 years during the period of 5-year follow-up. Association between PP and long-term mortality was confirmed by sensitivity analyses such as propensity score matching and multivariate Cox analyses. The matched cohort was developed by one-to-one, nearest-neighbor propensity score matching analyses.ResultsAmong patients with ACS, 113 (32.1%) admissions were alive, 240 (67.9%) were dead. There was a U-shaped association of mortality rate with PP, and the mortality rate increased in patients with PP equal to or less than 50  mmHg and greater than 70  mmHg. PP equal to or less than 50  mmHg was a predictor of the mortality rate in the overall cohort [hazard ratio: 1.92, 95% confidence interval (CI): 1.08-3.43, P = 0.027] and in the matched cohort (hazard ratio: 2.67, 95% CI: 1.16-6.14, P = 0.020). Moreover, PP equal to or less than 50  mmHg was independently related to mortality rate in the subgroup with hypertension in the overall cohort (hazard ratio: 2.04, 95% CI: 1.04-4.00, P = 0.039) and in the matched cohort (hazard ratio: 2.63, 95% CI: 1.01-6.83, P = 0.048).ConclusionThis study reveals a U-shaped association of mortality rate with PP in the octogenarians with ACS and demonstrates that PP equal to or less than 50  mmHg has an independent prognostic power in long-term all-cause mortality in the octogenarians with ACS as well as the subgroup with hypertension.

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