Pulse pressure, prehypertension, and mortality: the San Antonio heart study

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Updated: Jun 20, 2026

Measuring the Carotid to Femoral Pulse Wave Velocity (Cf-PWV) to Evaluate Arterial Stiffness
05:51

Measuring the Carotid to Femoral Pulse Wave Velocity (Cf-PWV) to Evaluate Arterial Stiffness

Published on: May 3, 2018

Carlos Lorenzo1, KoKo Aung, Michael P Stern

  • 1Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA. lorenzo@uthscsa.edu

American Journal of Hypertension
|August 22, 2009
PubMed

Insights

Prehypertension elevates mortality risk, especially with high pulse pressure, in individuals without diabetes or cardiovascular disease. Narrow pulse pressure may negate this increased risk.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Prehypertension is a known risk factor for increased mortality.
  • Pulse pressure is also independently associated with higher mortality rates.
  • The combined effect of prehypertension and pulse pressure on mortality in individuals without diabetes or cardiovascular disease remains unclear.

Purpose of the Study:

  • To investigate the impact of pulse pressure on the association between prehypertension and mortality.
  • To analyze mortality risk in individuals free of diabetes and cardiovascular disease based on blood pressure and pulse pressure levels.

Main Methods:

  • Utilized Cox regression analysis on data from 3,632 participants in the San Antonio Heart Study.
  • Follow-up duration averaged 15.2 years, with adjustments for age, sex, ethnicity, education, BMI, smoking, and cholesterol.
  • Blood pressure was categorized using the Joint Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines.

Main Results:

  • Prehypertension was present in 31.6% of participants; 218 deaths occurred during follow-up.
  • Prehypertension was associated with increased all-cause (HR 1.49) and cardiovascular mortality (HR 1.79).
  • Prehypertension combined with high pulse pressure significantly increased mortality (all-cause HR 2.14, cardiovascular HR 2.47), while low pulse pressure did not.

Conclusions:

  • Prehypertension independently increases all-cause and cardiovascular mortality risk in individuals without pre-existing diabetes or cardiovascular disease.
  • The association between prehypertension and mortality is not significant when pulse pressure is narrow.
  • Pulse pressure may be a critical factor to consider alongside systolic and diastolic blood pressure for risk assessment.
Abstract

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