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Circulation. 1999;100:354-360

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(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

Stanley S. Franklin, MD; Shehzad A. Khan, BS; Nathan D. Wong, PhD; Martin G. Larson, ScD; Daniel Levy, MD

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 {chi}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 SBP>=120 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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Eur Heart JHome page
A. A. Voors, C. J. Petrie, M. C. Petrie, A. Charlesworth, H. L. Hillege, F. Zijlstra, J. J. McMurray, and D. J. van Veldhuisen
Low pulse pressure is independently related to elevated natriuretic peptides and increased mortality in advanced chronic heart failure
Eur. Heart J., September 1, 2005; 26(17): 1759 - 1764.
[Abstract] [Full Text] [PDF]


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JAMAHome page
M. F. O'Rourke and M. E. Safar
Chronic Kidney Disease and Cardiovascular Risk
JAMA, August 17, 2005; 294(7): 791 - 791.
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CirculationHome page
G. F. Mitchell, A. L. DeStefano, M. G. Larson, E. J. Benjamin, M.-H. Chen, R. S. Vasan, J. A. Vita, and D. Levy
Heritability and a Genome-Wide Linkage Scan for Arterial Stiffness, Wave Reflection, and Mean Arterial Pressure: The Framingham Heart Study
Circulation, July 12, 2005; 112(2): 194 - 199.
[Abstract] [Full Text] [PDF]


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HypertensionHome page
M. T. Schram, C. G. Schalkwijk, A. H. Bootsma, J. H. Fuller, N. Chaturvedi, C. D.A. Stehouwer, and on behalf of the EURODIAB Prospective Complication
Advanced Glycation End Products Are Associated With Pulse Pressure in Type 1 Diabetes: The EURODIAB Prospective Complications Study
Hypertension, July 1, 2005; 46(1): 232 - 237.
[Abstract] [Full Text] [PDF]


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HypertensionHome page
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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HypertensionHome page
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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ChestHome page
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.
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ChestHome page
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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Arterioscler. Thromb. Vasc. Bio.Home page
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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HypertensionHome page
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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CirculationHome page
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.
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CirculationHome page
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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HypertensionHome page
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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HypertensionHome page
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.
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HypertensionHome page
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.
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CirculationHome page
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.
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Arterioscler. Thromb. Vasc. Bio.Home page
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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Diabetes CareHome page
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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HypertensionHome page
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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HypertensionHome page
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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J. Am. Soc. Nephrol.Home page
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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Cardiovasc ResHome page
P. Lacolley
Mechanical influence of cyclic stretch on vascular endothelial cells
Cardiovasc Res, September 1, 2004; 63(4): 577 - 579.
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CirculationHome page
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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HypertensionHome page
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]