Predictive Utility of Pulse Pressure and Other Blood Pressure Measures for Cardiovascular Outcomes

Abstract

Abstract-Data are sparse regarding the actual predictive utility of pulse pressure and other blood pressure measures for cardiovascular events. We included all of the participants from the Chicago Heart Association Detection Project in Industry who were free of cardiovascular disease and not receiving antihypertensive treatment at baseline (1967)(1968)(1969)(1970)(1971)(1972)(1973). Baseline blood pressure measures were assessed for predictive utility for fatal and nonfatal events over 33 years. Among 36 314 participants (mean age: 39Ϯ13 years; 43.4% women), there were 11 452 deaths: 745 were attributed to stroke, 2812 to coronary disease, and 599 to heart failure. Of the 16 393 participants who attained Medicare eligibility, 3050, 1367, and 2207 had Ն1 hospitalization for stroke, myocardial infarction, or heart failure, respectively. In univariate analyses, hazards ratios for stroke death per SD of pulse, systolic, and diastolic pressure, respectively, were 1.49, 1.75, and 1.71. Likelihood ratio 2 (134.3, 302.0, and 232.6, respectively), Bayes information criteria values (15 142, 14 974, and 15 044, respectively), and areas under receiver-operating characteristic curves (0.59, 0.64, and 0.63, respectively) all indicated better predictive utility for systolic and diastolic compared with pulse pressure. Results for coronary or heart failure death and stroke, myocardial infarction, or heart failure hospitalization were similar. Pulse pressure had weaker predictive utility at all ages but particularly for those Ͻ50 years. In this large cohort study, pulse pressure had predictive utility for cardiovascular events that was inferior to systolic or diastolic pressure. These findings support the approach of current guidelines in the use of systolic and diastolic blood pressure to assess risk and the need for treatment. Key Words: hypertension Ⅲ pulse pressure Ⅲ stroke Ⅲ coronary heart disease Ⅲ heart failure Ⅲ prediction H ypertension, currently defined by systolic (SBP) and diastolic (DBP) blood pressure (BP) levels according to Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines, is a major causal risk factor for stroke, coronary heart disease (CHD), and heart failure, 1-3 3 of the leading causes of morbidity and mortality in the United States. 1 In the last decade there has been controversy regarding the value of pulse pressure (PP), defined as SBP minus DBP, compared with traditional measures of SBP and DBP, for prediction of stroke, CHD, and heart failure outcomes. 4 -13 However, most studies have merely compared relative risks for single outcomes associated with PP, SBP, and DBP without assessing measures of true predictive utility, such as model fit, informativeness, and areas under receiver-operating characteristic curves.Thus, although PP has been shown to be associated with stroke, CHD, and heart failure, 4 -13 it remains controversial whether PP has greater predictive utility than SBP or DBP. Evidence of clear improvements in prediction with use of P...

Blood pressure components and risk for chronic kidney disease in middle-aged Japanese men: The Kansai Healthcare Study

“…Two large-scale, collaborative cohort studies and other recent cohort studies have reported that DBP has a strong or stronger relationship to the incidence of coronary heart disease than SBP until Bage 50; 8,11,12,32,33 thereafter, SBP and PP, but not DBP, were more influential. 8,12,[33][34][35] MAP was strongly related to the risk of coronary heart disease over a wide age range.…”

“…[15][16][17][35][36][37][38] Recently, three large-scale collaborative cohort studies and several large-scale cohort studies have examined BP components in relation to the risk of stroke by age group. 8,[11][12][13][14] These studies have reported that the relation of DBP to stroke incidence was as strong as or stronger than that of SBP until Bage 60-65; 8,[11][12][13][14]39 thereafter, the relation of SBP to stroke incidence was stronger than that of DBP. 8,[12][13][14]35 In addition, MAP was strongly related to stroke risk over a wide age range.…”

“…8,[12][13][14]35 In addition, MAP was strongly related to stroke risk over a wide age range. 8,[11][12][13][14] However, PP was not associated with the risk of stroke after adjusting for MAP in both middle-aged and older subjects. 13,14 These results suggest that each BP component might have a different role in organ damage at different ages.…”

“…[3][4][5][6][7] Some epidemiological studies have focused on which blood pressure (BP) components are superior as predictors of cardiovascular diseases, including systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) and mean arterial pressure (MAP). [8][9][10][11][12][13][14][15][16][17] However, the BP components that are the most important risks factor for CKD are currently unknown.…”

Family history of diabetes modifies the effect of blood pressure for incident diabetes in Middle Eastern women: Tehran Lipid and Glucose Study

“…21 In the women of Finnmark Study, DBP was associated with incident diabetes in the age-adjusted model but not in the multivariable-adjusted model. 22 Although many studies examined PP and MAP as predictors of CVD, 23,24 there is lack of data regarding the effect of these components for prediction of diabetes, compared with other BP components. Kramer et al 21 in the Rancho Bernardo study showed that 10 mm Hg increases in PP causes a 20% increase in risk of diabetes in the multivariable-adjusted model.…”