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Pulse pressure and cardiovascular risk
1Centre IPC and INSERM U 337, Paris, France.
Insights
Diastolic blood pressure (DBP) is an unreliable cardiovascular risk predictor. Widened pulse pressure (PP), the difference between systolic and diastolic blood pressure, is a superior indicator of cardiac events and mortality risk.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Medicine
Background:
- Elevated diastolic blood pressure (DBP) and systolic blood pressure (SBP) correlate with cardiac events.
- DBP was historically favored for cardiovascular risk assessment due to smaller variations.
- Recent findings challenge DBP's reliability, indicating SBP increases with age while DBP plateaus.
Purpose of the Study:
- To evaluate the predictive value of diastolic blood pressure (DBP) for cardiovascular events.
- To investigate the role of pulse pressure (PP) as a predictor of cardiovascular risk.
- To determine if PP is a more reliable indicator of cardiac events than traditional blood pressure measures.
Main Methods:
- Analysis of existing studies and data on blood pressure readings and cardiac events.
- Comparison of the predictive accuracy of DBP, SBP, and PP for cardiovascular outcomes.
- Examination of the impact of arterial stiffening and peripheral vascular resistance on blood pressure readings.
Main Results:
- DBP can be misleading, masking underlying cardiovascular risks due to counteracting physiological factors.
- Systolic blood pressure (SBP) is a more consistent indicator of age-related cardiovascular risk.
- Widened pulse pressure (PP) is strongly associated with increased risk of mortality and myocardial infarction, even in normotensive individuals.
Conclusions:
- Diastolic blood pressure (DBP) is no longer a reliable predictor of cardiovascular events.
- Pulse pressure (PP) emerges as a superior and independent predictor of cardiovascular risk.
- Measuring PP offers a more accurate assessment of cardiac event risk, particularly in older adults and those with isolated systolic hypertension.
Abstract:
Numerous studies have shown that increases in diastolic (DBP) and systolic (SBP) blood pressure are positively associated with cardiac events. Since DBP typically varies by smaller amounts, it has historically been the blood pressure value used most often to assess the risk of cardiovascular disease. Further studies have indicated, however, that SBP continues to increase proportionally with age, while DBP levels off. New data have emerged which suggest that DBP can no longer be valued as a reliable predictor of cardiovascular events and may even be diagnostically misleading. Normal levels of DBP can be indicative of a combination of an increase in peripheral vascular resistance (which elevates DBP) with an increase in arterial stiffening (which decreases DBP). These two phenomena 'cancel' each other out; the underlying risk factors are disguised by the apparent normalcy of the DBP reading. DBP is even less of an indicator in older adults, where the prevailing form of hypertension is isolated systolic hypertension and the most common cause is large-artery stiffness. Since arterial stiffening causes SBP to increase and DBP to decrease, the gap between the two, pulse pressure (PP), may be the best predictor of cardiac events for all the blood pressure values. Several studies have confirmed that subjects with the widest PP have the greatest risk of mortality. Pulse pressure has also been observed to be a significant and independent indicator of myocardial infarction. Furthermore, compelling evidence has emerged that PP is a strong indicator of cardiovascular risk even among normotensive individuals.