Single versus combined blood pressure components and risk for cardiovascular disease: the Framingham Heart Study

Area of Science:

• Cardiology
• Epidemiology
• Biostatistics

Background:

• The predictive value of single versus combined blood pressure (BP) components for cardiovascular disease (CVD) events remains unclear.
• This study investigated the utility of systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP) individually and in combination for CVD event prediction.

Purpose of the Study:

• To compare the effectiveness of single BP components against combined BP components (SBP+DBP and PP+MAP) in predicting CVD events.
• To assess the incremental predictive value of combining different BP measures.

Main Methods:

• Utilized data from the Framingham Heart Study (original and offspring cohorts) comprising 9657 participants.
• Employed pooled logistic regression with BP components analyzed both categorically and continuously.
• Assessed model fit improvements and significant interactions between BP components.

Main Results:

• Combined BP components (SBP+DBP and PP+MAP) significantly improved model fit compared to individual BP components (P<0.05 to P<0.0001).
• Significant interactions were observed between SBP and DBP (P=0.02), and PP and MAP (P=0.01).
• Models using continuous SBP+DBP and PP+MAP showed identical predictive performance for CVD events. Adding a quadratic DBP term further enhanced prediction.

Conclusions:

• Combined BP components (PP+MAP and SBP+DBP) offer superior prediction of CVD events compared to single BP components.
• The predictive capability of combined measures varied with the level of each component.
• While PP+MAP may offer hemodynamic insights, SBP+DBP demonstrated comparable predictive power for CVD events.