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Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham heart study
S S Franklin1, S A Khan, N D Wong
1Heart Disease Prevention Program, University of California, Irvine, USA. sfrankln@ucla.edu
Insights
Pulse pressure (PP) provides valuable information for predicting coronary heart disease (CHD) risk in older adults. Higher PP, especially with lower diastolic blood pressure (DBP) at higher systolic blood pressure (SBP) levels, indicates increased CHD risk.
Area of Science:
- Cardiology
- Epidemiology
- Hypertension Research
Background:
- Current hypertension definitions rely on systolic blood pressure (SBP) and diastolic blood pressure (DBP), omitting pulse pressure (PP).
- The predictive value of PP for coronary heart disease (CHD) risk remains under-examined in population-based studies.
Purpose of the Study:
- To investigate whether pulse pressure (PP) offers additional predictive information for coronary heart disease (CHD) risk beyond traditional blood pressure measures.
- To assess the independent and combined contributions of SBP, DBP, and PP in predicting long-term CHD risk.
Main Methods:
- Analysis of 1924 participants aged 50-79 from the Framingham Heart Study, free of CHD and antihypertensive medication at baseline.
- Utilized Cox regression over a 20-year follow-up, adjusting for age, sex, and other cardiovascular risk factors.
- Examined individual and joint associations of SBP, DBP, and PP with incident CHD events.
Main Results:
- Individually, SBP, DBP, and PP were associated with CHD risk, with PP showing the strongest association (largest chi(2) statistic).
- When SBP and DBP were analyzed together, SBP remained a positive predictor (HR 1.22), while DBP showed a negative association (HR 0.86).
- In subgroups, higher PP consistently predicted increased CHD risk, particularly when DBP was low at elevated SBP levels (SBP ≥ 120 mm Hg).
Conclusions:
- Pulse pressure (PP) is a significant independent predictor of coronary heart disease (CHD) risk in middle-aged and elderly individuals.
- Lower diastolic blood pressure (DBP) at higher systolic blood pressure (SBP) levels (SBP ≥ 120 mm Hg) is associated with increased CHD risk, highlighting the importance of PP.
- Neither SBP nor DBP alone is superior to PP in predicting CHD risk, suggesting PP should be considered in cardiovascular risk assessment.
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.
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