This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: 119/2/243    most recent CIRCULATIONAHA.108.797936v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Franklin, S. S. Articles by Levy, D. Search for Related Content PubMed PubMed Citation Articles by Franklin, S. S. Articles by Levy, D. Related Collections Risk Factors Clinical Studies Epidemiology Related Article

(Circulation. 2009;119:243-250.)
© 2009 American Heart Association, Inc.

Epidemiology

Single Versus Combined Blood Pressure Components and Risk for Cardiovascular Disease

The Framingham Heart Study

Stanley S. Franklin, MD; Victor A. Lopez, BS; Nathan D. Wong, PhD; Gary F. Mitchell, MD; Martin G. Larson, ScD; Ramachandran S. Vasan, MD; Daniel Levy, MD

From the Heart Disease Prevention Program, University of California, Irvine (S.S.F., V.A.L., N.D.W.); National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Mass (M.G.L., R.S.V., D.L.); Cardiovascular Engineering, Norwood, Mass (G.F.M.); Division of Cardiology, Boston Medical Center, Boston, Mass (R.S.V.); Center for Population Studies of the National Heart, Lung, and Blood Institute, Bethesda, Md (D.L.); and Department of Mathematics and Statistics, Boston University, Boston, Mass (M.G.L.).

Correspondence to Stanley S. Franklin, MD, Heart Disease Prevention Program, Department of Medicine, C240 Medical Sciences, University of California, Irvine, CA 92697. E-mail ssfranklinmd{at}earthlink.net

Received June 9, 2008; accepted October 14, 2008.

Background— The utility of single versus combined blood pressure (BP) components in predicting cardiovascular disease (CVD) events is not established. We compared systolic BP (SBP) and diastolic BP (DBP) versus pulse pressure (PP) and mean arterial pressure (MAP) combined and each of these 4 BP components alone in predicting CVD events.

Methods and Results— In participants in the original (n=4760) and offspring (n=4897) Framingham Heart Study who were free of CVD events and BP-lowering therapy, 1439 CVD events occurred over serial 4-year intervals from 1952 to 2001. In pooled logistic regression with the use of BP categories, combining SBP with DBP and PP with MAP improved model fit compared with individual BP components (P<0.05 to P<0.0001). Significant interactions were noted between SBP and DBP (P=0.02) and between PP and MAP (P=0.01) in their respective multivariable models. Models with continuous variables for SBP+DBP and PP+MAP proved identical in predicting CVD events (Akaike Information Criteria=10 625 for both). Addition of a quadratic DBP² term to DBP and SBP further improved fit (P=0.0016).

Conclusions— Combining PP with MAP and SBP with DBP produced models that were superior to single BP components for predicting CVD, and the extent of CVD risk varied with the level of each BP component. The combination of PP+MAP (unlike SBP+DBP) has a monotonic relation with risk and may provide greater insight into hemodynamics of altered arterial stiffness versus impaired peripheral resistance but is not superior to SBP+DBP in predicting CVD events.

---

 

CLINICAL PERSPECTIVE

Related Article:

Clinical Summaries
Circulation 2009 119: 201-203. [Extract] [Full Text]

This article has been cited by other articles:

				R. L. Sacco, M. Khatri, T. Rundek, Q. Xu, H. Gardener, B. Boden-Albala, M. R. Di Tullio, S. Homma, M. S.V. Elkind, and M. C. Paik Improving Global Vascular Risk Prediction With Behavioral and Anthropometric Factors The Multiethnic NOMAS (Northern Manhattan Cohort Study). J. Am. Coll. Cardiol., December 8, 2009; 54(24): 2303 - 2311. [Abstract] [Full Text] [PDF]

				F. H. Messerli and G. S. Panjrath The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential? J. Am. Coll. Cardiol., November 10, 2009; 54(20): 1827 - 1834. [Abstract] [Full Text] [PDF]

				A.-P. Kengne, S. Czernichow, R. Huxley, D. Grobbee, M. Woodward, B. Neal, S. Zoungas, M. Cooper, P. Glasziou, P. Hamet, et al. Blood Pressure Variables and Cardiovascular Risk: New Findings From ADVANCE Hypertension, August 1, 2009; 54(2): 399 - 404. [Abstract] [Full Text] [PDF]

				S. Bangalore, F. H. Messerli, S. S. Franklin, G. Mancia, A. Champion, and C. J. Pepine Pulse pressure and risk of cardiovascular outcomes in patients with hypertension and coronary artery disease: an INternational VErapamil SR-trandolapril STudy (INVEST) analysis Eur. Heart J., June 1, 2009; 30(11): 1395 - 1401. [Abstract] [Full Text] [PDF]

				G. Schillaci, M. Pirro, and E. Mannarino Assessing Cardiovascular Risk: Should We Discard Diastolic Blood Pressure? Circulation, January 20, 2009; 119(2): 210 - 212. [Full Text] [PDF]