Cross-national heterogeneity in the epidemiological determinants and predictive value of wide pulse pressure for cardiovascular and cerebrovascular outcomes

Abstract

AbstractBackground & Objective Wide pulse pressure (WPP), a hemodynamic marker of large artery stiffness and vascular aging, is a well-established predictor of cardiovascular and cerebrovascular events. However, its epidemiological distribution and independent predictive value across different populations remain insufficiently understood. This dissertation aims to examine the prevalence of WPP among older adults in the United States and China and evaluates its longitudinal associations with incident heart disease and stroke. Methods This study analyzed harmonized data from two nationally representative prospective cohorts: the U.S. Health and Retirement Study (HRS, 2012–2016) and the China Health and Retirement Longitudinal Study (CHARLS, 2011–2015). Cross-sectional analyses first assessed the prevalence of WPP (pulse pressure > 60 mmHg) and its sociodemographic correlates. Longitudinal analyses excluded participants with baseline cardiovascular or cerebrovascular diseases. Modified Poisson regression with generalized estimating equations (GEE) was used to estimate adjusted relative risks (RRs) for incident heart disease and stroke, controlling for demographic, anthropometric, and clinical factors. Results Despite being younger on average, the Chinese cohort had a higher prevalence of WPP than the U.S. cohort. Prospectively, WPP independently predicted incident heart disease in the U.S., but this association was attenuated in China after adjustment, where uncontrolled hypertension and obesity were stronger predictors. In contrast, WPP remained an independent predictor of incident stroke in both populations. Conclusion WPP is a robust predictor of stroke risk among older adults across populations. However, its association with heart disease varies by context, likely reflecting differences in risk factor profiles and disease management. These findings support the use of WPP as an objective marker for cardiovascular risk stratification, particularly in populations with low chronic disease awareness.