(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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