Pulse Pressure May Be the Best Predictor of Cardiovascular Mortality

Pulse pressure is the best predictor of cardiovascular mortality.

"Hypertension is a dominant characteristic in the prediction of cardiovascular diseases (CVDs)," write Demosthenes B. Panagiotakos, PhD, from Harokopio University in Athens, Greece, and colleagues from the Seven Countries Study. "The effect of blood pressure [BP] and especially pulse pressure on cardiovascular mortality has rarely been compared among populations."
From 1958 to 1964, 12,763 men, aged 40 to 59 years, from the U.S., Japan, Italy, Greece, former Yugoslavia, Finland, and the Netherlands, were surveyed. Follow-up for vital status and cause of death continued for 25 years.

Compared with age, physical activity, total serum cholesterol level, body mass index, height, and smoking, all baseline BP measurements were the best predictors of CVD mortality. Pulse pressure and diastolic and systolic BPs were the best predictors for CVD death followed by mean and mid BPs.

Differences between cohorts were not significant, with the age-adjusted hazard ratio (HR) per 10–mm Hg increase in pulse pressure varying from 1.19 in the U.S. (P = .04) to 1.29 in southern Europe (P = .01). In the pooled cohorts, pulse pressure measurements were also associated with increased risk of coronary heart disease (HR per 10–mm Hg increase, 1.15; P = .04) and of stroke death (HR per 10–mm Hg increase, 1.32; P = .01).

BP measurements, including pulse pressure and systolic, diastolic, mean, and mid BP, are predictive of CVD death in men without baseline CVD. For every 10–mm Hg rise in pulse pressure, there is a 22% increase in the HR for CVD death. For every 5–mm Hg rise in diastolic BP, there is a 16% increase in the HR. For every 10–mm Hg increase in systolic, mean, and mid BP measurements, the HRs were 22%, 42%, and 38%, respectively.

"Pulse pressure followed by diastolic and systolic blood pressures, were the best predictors for CVD mortality among other blood pressures, as well as age, physical activity, total serum cholesterol level, anthropometric indexes, and smoking habits," the authors write. "No significant differences were observed among the different populations studied."

"Blood pressure measurements were significant long-term predictors of CVD death, and despite the high correlation of pulse pressure with systolic blood pressure, pulse pressure predominates in predicting cardiovascular death in middle-aged men," the authors conclude. "Moreover, the relative increase in long-term mortality due to CVD for a given increase in pulse pressure was similar in various populations, whereas the absolute risk at the same level of pulse pressure varied substantially."
Arch Intern Med. 2005;165:2142-2147