(Hypertension. 2000;36:801.)
© 2000 American Heart Association, Inc.
Scientific Contributions |
Systolic and Diastolic Blood Pressure, Pulse Pressure, and Mean Arterial Pressure as Predictors of Cardiovascular Disease Risk in Men
From the Division of Preventive Medicine (H.D.S., J.M.G., J.E.M., R.J.G.), Cardiovascular Division (J.M.G.), and Channing Laboratory (M.J.S., B.R., J.E.M.), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School; Departments of Epidemiology (H.D.S., M.J.S., J.E.M.), Nutrition (M.J.S.), and Biostatistics (R.J.G.), Harvard School of Public Health; and Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Medical Center (J.M.G.), Boston, Mass. Dr Hennekens is currently Visiting Professor of Medicine, Epidemiology, and Public Health at the University of Miami School of Medicine, and his current address is 1415 West Camino Real, Boca Raton, FL 33486.
Abstract—We compared
systolic blood pressure (SBP), diastolic blood
pressure (DBP), pulse pressure (PP), and mean arterial
pressure (MAP) in predicting the risk of cardiovascular
disease (CVD), stratifying results at age 60 years, when DBP decreases
while SBP continues to increase. We prospectively followed 11 150 male
physicians with no history of CVD or antihypertensive treatment through
the 2-year questionnaire, after which follow-up began. Reported blood
pressure was averaged from both the baseline and 2-year questionnaires.
During a median follow-up of 10.8 years, there were 905 cases of
incident CVD. For men aged <60 years (n=8743), those in the highest
versus lowest quartiles of average SBP (
130 versus <116
mm Hg), DBP (81 versus <73 mm Hg), and MAP (97 versus
<88 mm Hg) had relative risks (RRs) of CVD of 2.16, 2.23, and
2.52, respectively. Models with average MAP and PP did not add
information compared with models with MAP alone
(P>0.05). For men aged 60 years (n=2407), those in
the highest versus lowest quartiles of average SBP (135 versus
<120 mm Hg), PP (55 versus <44 mm Hg), and MAP (99
versus <91 mm Hg) had RRs of CVD of 1.69, 1.83, and 1.43,
respectively. The addition of other blood pressure measures did not add
information compared with average SBP or PP alone (all
P>0.05). These data suggest that average SBP, DBP, and
MAP strongly predict CVD among younger men, whereas either average SBP
or PP predicts CVD among older men. More research should distinguish
whether MAP, highly correlated with SBP and DBP, better predicts
CVD.
Key Words: blood pressure • coronary artery disease • stroke • epidemiology • aging
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