Association of pulse pressure with all-cause mortality in young adults

Background Pulse blood pressure was significantly associated with all-cause mortality in middle-aged and elderly populations, but less evidence was known in young adults. Objective To assess the association of pulse pressure (PP) with all-cause mortality in young adults. Methods This cohort from the 1999-2006 National Health and Nutrition Examination Survey included adults aged 18-40 years. All included participants were followed up until the date of death or 31 December 2015. PP was categorised into three groups: <50, 50∼60, ≥60 mm Hg. Cox proportional hazards models and subgroup analysis were performed to estimate the adjusted HRs and 95% CIs for all-cause mortality. Results After applying the exclusion criteria, 8356 participants (median age 26.63±7.01 years, 4598 women (55.03%)) were included, of which 265 (3.17%) have died during a median follow-up duration of 152.96±30.45 months. When treating PP as a continuous variable, multivariate Cox analysis showed that PP was an independent risk factor for all-cause mortality (HR 1.94, 95% CI 1.02 to 3.69; p=0.0422). When using PP<50 mm Hg as referent, from the 50∼60 mm Hg to the ≥60 mm Hg group, the risks of all-cause mortality for participants with PP ranging 50-60 mm Hg or ≥60 mm Hg were 0.93 (95% CI 0.42 to 2.04) and 1.15 (95% CI 0.32 to 4.07) (P for tend was 0.959). Subgroup analysis showed that PP (HR 2.00, 95% CI 1.05 to 3.82; p=0.0360) was associated with all-cause mortality among non-hypertensive participants. Conclusion Among young adults, higher PP was significantly associated with an increased risk of all-cause mortality, particularly among those without hypertension.