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Pulse pressure and cardiovascular disease-related mortality: follow-up study of the Multiple Risk Factor Intervention

Michael Domanski1, Gary Mitchell, Marc Pfeffer

  • 1Division of Biostatistics, School of Public Health, 2221 University Ave SE, Room 200, Minneapolis, MN 55414, USA.

JAMA
|May 22, 2002
PubMed

Insights

Systolic and diastolic blood pressure (SBP/DBP) are better predictors of cardiovascular disease mortality than pulse pressure. Combining SBP and DBP improves risk assessment in men.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • The Joint National Committee (JNC-VI) classification uses systolic blood pressure (SBP) and diastolic blood pressure (DBP) for cardiovascular disease (CVD) risk. Pulse pressure is also considered a potential risk factor.
  • Understanding the independent and combined predictive values of SBP, DBP, and pulse pressure is crucial for accurate CVD risk stratification.

Purpose of the Study:

  • To compare the relationships of SBP, DBP, and pulse pressure, both individually and jointly, with CVD-related mortality in men.
  • To evaluate how these blood pressure parameters relate to mortality across different JNC-VI categories and age groups.

Main Methods:

  • Utilized data from the Multiple Risk Factor Intervention Trial (MRFIT) including 342,815 men aged 35-57 screened between 1973-1975.
  • Classified participants' blood pressure according to JNC-VI categories based on SBP and DBP, and calculated pulse pressure.
  • Assessed CVD-related mortality through 1996, analyzing relationships with SBP, DBP, and pulse pressure.

Main Results:

  • A total of 25,721 CVD-related deaths were recorded.
  • SBP and DBP demonstrated stronger associations with CVD-related mortality compared to pulse pressure.
  • Concordant elevations in SBP and DBP increased mortality risk in both age groups; higher SBP with lower DBP also elevated risk in older men (45-57 years).

Conclusions:

  • Considering both SBP and DBP together provides improved cardiovascular disease risk assessment compared to evaluating SBP, DBP, or pulse pressure in isolation.
  • This combined approach enhances risk stratification for men across different age brackets.
Abstract

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