(Circulation. 1999;100:354-360.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Is Pulse Pressure Useful in Predicting Risk for Coronary Heart Disease?
The Framingham Heart Study
From the Heart Disease Prevention Program, University of California, Irvine (S.S.F., S.A.K., N.D.W.); The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass (M.G.L., D.L.); and the National Heart, Lung, and Blood Institute, Bethesda, Md (D.L.).
Correspondence to Dr Stanley S. Franklin, UCI Heart Disease Prevention Program, C240 Medical Sciences, University of California Irvine, Irvine, CA 92697. E-mail sfrankln{at}ucla.edu
Background—Current definitions of hypertension are based on levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP), but not on pulse pressure (PP). We examined whether PP adds useful information for predicting coronary heart disease (CHD) in the population-based Framingham Heart Study.
Methods and Results—We studied 1924 men and women between 50 and
79 years of age at baseline with no clinical evidence of CHD and not
taking antihypertensive drug therapy. Cox regression, adjusted for age,
sex, and other risk factors, was used to assess the relations between
blood pressure components and CHD risk over a 20-year follow-up. The
association with CHD risk was positive for SBP, DBP, and PP,
considering each pressure individually; of the 3, PP yielded the
largest 
2 statistic. When SBP and DBP were jointly
entered into the multivariable model, the association with CHD risk
was positive for SBP (HR, 1.22; 95% CI, 1.15 to 1.30) and negative for
DBP (HR, 0.86; 95% CI, 0.75 to 0.98). Four subgroups were defined
according to SBP levels (<120, 120 to 139, 140 to 159, and 
160
mm Hg). Within each subgroup, the association with CHD risk was
negative for DBP and positive for PP. A cross-classification of SBP-DBP
levels confirmed these results.
Conclusions—In the middle-aged and elderly, CHD risk increased
with lower DBP at any level of SBP120 mm Hg, suggesting that higher
PP was an important component of risk. Neither SBP nor DBP was superior
to PP in predicting CHD risk.
Key Words: blood pressure • hypertension • coronary disease
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C. A. Peralta, L. S. Hicks, G. M. Chertow, J. Z. Ayanian, E. Vittinghoff, F. Lin, and M. G. Shlipak Control of Hypertension in Adults With Chronic Kidney Disease in the United States Hypertension, June 1, 2005; 45(6): 1119 - 1124. [Abstract] [Full Text] [PDF]
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G. Schillaci, M. Pirro, G. Vaudo, M. R. Mannarino, G. Savarese, G. Pucci, S. S. Franklin, and E. Mannarino Metabolic Syndrome Is Associated With Aortic Stiffness in Untreated Essential Hypertension Hypertension, June 1, 2005; 45(6): 1078 - 1082. [Abstract] [Full Text] [PDF]
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 H. O. Ventura and M. R. Mehra The Interaction of Vascular Stiffness and Cardiovascular Events in Women: Insights From the Heart and Estrogen/Progestin Replacement Study Chest, May 1, 2005; 127(5): 1477 - 1480. [Full Text] [PDF]
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G. V. Nair, L. A. Chaput, E. Vittinghoff, D. M. Herrington, and for the Heart and Estrogen/Progestin Replacement S Pulse Pressure and Cardiovascular Events in Postmenopausal Women With Coronary Heart Disease Chest, May 1, 2005; 127(5): 1498 - 1506. [Abstract] [Full Text] [PDF]
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S. J. Zieman, V. Melenovsky, and D. A. Kass Mechanisms, Pathophysiology, and Therapy of Arterial Stiffness Arterioscler. Thromb. Vasc. Biol., May 1, 2005; 25(5): 932 - 943. [Abstract] [Full Text] [PDF]
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M. Hernelahti, H. O. Tikkanen, J. Karjalainen, and U. M. Kujala Muscle Fiber-Type Distribution as a Predictor of Blood Pressure: A 19-Year Follow-Up Study Hypertension, May 1, 2005; 45(5): 1019 - 1023. [Abstract] [Full Text] [PDF]
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H. Senzaki, C.-H. Chen, H. Ishido, S. Masutani, T. Matsunaga, M. Taketazu, T. Kobayashi, N. Sasaki, S. Kyo, and Y. Yokote Arterial Hemodynamics in Patients After Kawasaki Disease Circulation, April 26, 2005; 111(16): 2119 - 2125. [Abstract] [Full Text] [PDF]
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R. Sega, R. Facchetti, M. Bombelli, G. Cesana, G. Corrao, G. Grassi, and G. Mancia Prognostic Value of Ambulatory and Home Blood Pressures Compared With Office Blood Pressure in the General Population: Follow-Up Results From the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) Study Circulation, April 12, 2005; 111(14): 1777 - 1783. [Abstract] [Full Text] [PDF]
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F. Fyhrquist, B. Dahlof, R. B. Devereux, S. E. Kjeldsen, S. Julius, G. Beevers, U. de Faire, H. Ibsen, K. Kristianson, O. Lederballe-Pedersen, et al. Pulse Pressure and Effects of Losartan or Atenolol in Patients With Hypertension and Left Ventricular Hypertrophy Hypertension, April 1, 2005; 45(4): 580 - 585. [Abstract] [Full Text] [PDF]
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J. C. Verhave, P. Fesler, G. du Cailar, J. Ribstein, M. E. Safar, and A. Mimran Elevated Pulse Pressure Is Associated With Low Renal Function in Elderly Patients With Isolated Systolic Hypertension Hypertension, April 1, 2005; 45(4): 586 - 591. [Abstract] [Full Text] [PDF]
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G. de Simone, M. J. Roman, M. H. Alderman, M. Galderisi, O. de Divitiis, and R. B. Devereux Is High Pulse Pressure a Marker of Preclinical Cardiovascular Disease? Hypertension, April 1, 2005; 45(4): 575 - 579. [Abstract] [Full Text] [PDF]
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T. G. Pickering, J. E. Hall, L. J. Appel, B. E. Falkner, J. Graves, M. N. Hill, D. W. Jones, T. Kurtz, S. G. Sheps, and E. J. Roccella Recommendations for Blood Pressure Measurement in Humans and Experimental Animals: Part 1: Blood Pressure Measurement in Humans: A Statement for Professionals From the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research Circulation, February 8, 2005; 111(5): 697 - 716. [Abstract] [Full Text] [PDF]
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Yasmin, S. Wallace, C. M. McEniery, Z. Dakham, P. Pusalkar, K. Maki-Petaja, M. J. Ashby, J. R. Cockcroft, and I. B. Wilkinson Matrix Metalloproteinase-9 (MMP-9), MMP-2, and Serum Elastase Activity Are Associated With Systolic Hypertension and Arterial Stiffness Arterioscler. Thromb. Vasc. Biol., February 1, 2005; 25(2): 372 - 378. [Abstract] [Full Text] [PDF]
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S. Nakano, K. Konishi, K. Furuya, K. Uehara, M. Nishizawa, A. Nakagawa, T. Kigoshi, and K. Uchida A Prognostic Role of Mean 24-h Pulse Pressure Level for Cardiovascular Events in Type 2 Diabetic Subjects Under 60 Years of Age Diabetes Care, January 1, 2005; 28(1): 95 - 100. [Abstract] [Full Text] [PDF]
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T. G. Pickering, J. E. Hall, L. J. Appel, B. E. Falkner, J. Graves, M. N. Hill, D. W. Jones, T. Kurtz, S. G. Sheps, and E. J. Roccella Recommendations for Blood Pressure Measurement in Humans and Experimental Animals: Part 1: Blood Pressure Measurement in Humans: A Statement for Professionals From the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research Hypertension, January 1, 2005; 45(1): 142 - 161. [Abstract] [Full Text] [PDF]
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K. Miura, Y. Soyama, Y. Morikawa, M. Nishijo, Y. Nakanishi, Y. Naruse, K. Yoshita, S. Kagamimori, and H. Nakagawa Comparison of Four Blood Pressure Indexes for the Prediction of 10-Year Stroke Risk in Middle-Aged and Older Asians Hypertension, November 1, 2004; 44(5): 715 - 720. [Abstract] [Full Text] [PDF]
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S. Mustata, C. Chan, V. Lai, and J. A. Miller Impact of an Exercise Program on Arterial Stiffness and Insulin Resistance in Hemodialysis Patients J. Am. Soc. Nephrol., October 1, 2004; 15(10): 2713 - 2718. [Abstract] [Full Text] [PDF]
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P. Lacolley Mechanical influence of cyclic stretch on vascular endothelial cells Cardiovasc Res, September 1, 2004; 63(4): 577 - 579. [Full Text] [PDF]
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M. Ronnback, J. Fagerudd, C. Forsblom, K. Pettersson-Fernholm, A. Reunanen, P.-H. Groop, and on behalf of the Finnish Diabetic Nephropathy Stu Altered Age-Related Blood Pressure Pattern in Type 1 Diabetes Circulation, August 31, 2004; 110(9): 1076 - 1082. [Abstract] [Full Text] [PDF]
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A. L. DeStefano, M. G. Larson, G. F. Mitchell, E. J. Benjamin, R. S. Vasan, J. Li, D. Corey, and D. Levy Genome-Wide Scan for Pulse Pressure in the National Heart, Lung and Blood Institute's Framingham Heart Study Hypertension, August 1, 2004; 44(2): 152 - 155. [Abstract] [Full Text] [PDF]
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