Late-Life Increases in Pulmonary Pressure, Hypertension

TOPLINE:

Pulmonary artery systolic pressure (PASP) increases during late life and predicts the development of dyspnea, highlighting the importance of risk factor assessment and control over the life course, researchers say.

METHODOLOGY:

Investigators quantified longitudinal changes in PASP over the 6 years between ages 75.5 and 81.5 years in 1420 adults (68% women, 24% Black) in the Atherosclerosis Risk in Communities (ARIC) study.
PASP was estimated by Doppler echo from the systolic right ventricular to right atrial pressure gradient using the modified Bernoulli equation. Right atrial pressure was assumed to be 5 mmHg and then added to the calculated gradient to yield PASP.
Multivariable regression analysis was used to determine the extent to which cardiac and pulmonary dysfunction associate with change in PASP and to define the relationships of changes in PASP with dyspnea.

TAKEAWAY:

Over the 6 years, PASP increased by 5 ± 8 mmHg — from 28 ± 5 mmHg at age 75.5 years to 33 ± 8 mmHg at age 81.5 years, with greater increases observed in older adults. The prevalence of pulmonary hypertension increased from 3% to 25%.
Increases in pulmonary pressure correlated with onset of dyspnea in late life. Each 5-mmHg increase in PASP was associated with 16% higher odds of developing dyspnea.
LV systolic/diastolic, pulmonary, and renal dysfunction were each associated with greater increases in PASP. Increases in PASP correlated with increases in E/e’ ratio and left atrial volume index, consistent with concomitant increases in LV filling pressure.

IN PRACTICE:

"Primary prevention of end-organ damage in mid- and late-life may help mitigate worsening pulmonary pressure in late-life," the authors write.

This study "greatly expands our current understanding on cardiac remodeling and the development of dyspnea at older age. The presented results should raise our awareness of risk factor assessment and control over the life course," add the co-authors of an editorial.

SOURCE:

The study, with first author Rani Zierath, BS, with Brigham and Women's Hospital, Boston, Massachusetts, was published online November 27 in the Journal of the American College of Cardiology.

LIMITATIONS:

Right heart catheterization is the gold standard for measuring pulmonary pressure, and the echocardiographic determination of PASP may introduce misclassification. Tricuspid regurgitation was only assessable in 58% of participants at age 75.5 years. There was no follow-up information after age 81.5 years regarding cardiovascular outcomes such as incident heart failure, which limits the ability to assess the prognostic value of changes in PASP in late life.

DISCLOSURES:

The ARIC study has been funded by the National Institutes of Health. Zierath reports no relevant financial relationships. One author has received consulting fees from Philips Ultrasound and Janssen, and research funds from Novartis. Another reported consulting fees from Astellas Inc. and research support from ABT Associates.

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