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(Hypertension. 2007;49:1256.)
© 2007 American Heart Association, Inc.

Original Articles

Predictive Utility of Pulse Pressure and Other Blood Pressure Measures for Cardiovascular Outcomes

From the Bluhm Cardiovascular Institute (D.M.L.-J., P.G.), the Department of Medicine (W.J.M., D.M.L.-J., P.G.), and the Department of Preventive Medicine (D.M.L-J., D.B.G., P.G.), Feinberg School of Medicine, Northwestern University, Chicago, Ill.

Correspondence to Donald M. Lloyd-Jones, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, Suite 1102, Chicago, IL 60611. E-mail dlj{at}northwestern.edu

Data are sparse regarding the actual predictive utility of pulse pressure and other blood pressure measures for cardiovascular events. We included all of the participants from the Chicago Heart Association Detection Project in Industry who were free of cardiovascular disease and not receiving antihypertensive treatment at baseline (1967–1973). Baseline blood pressure measures were assessed for predictive utility for fatal and nonfatal events over 33 years. Among 36 314 participants (mean age: 39±13 years; 43.4% women), there were 11 452 deaths: 745 were attributed to stroke, 2812 to coronary disease, and 599 to heart failure. Of the 16 393 participants who attained Medicare eligibility, 3050, 1367, and 2207 had 1 hospitalization for stroke, myocardial infarction, or heart failure, respectively. In univariate analyses, hazards ratios for stroke death per SD of pulse, systolic, and diastolic pressure, respectively, were 1.49, 1.75, and 1.71. Likelihood ratio ² (134.3, 302.0, and 232.6, respectively), Bayes information criteria values (15 142, 14 974, and 15 044, respectively), and areas under receiver-operating characteristic curves (0.59, 0.64, and 0.63, respectively) all indicated better predictive utility for systolic and diastolic compared with pulse pressure. Results for coronary or heart failure death and stroke, myocardial infarction, or heart failure hospitalization were similar. Pulse pressure had weaker predictive utility at all ages but particularly for those <50 years. In this large cohort study, pulse pressure had predictive utility for cardiovascular events that was inferior to systolic or diastolic pressure. These findings support the approach of current guidelines in the use of systolic and diastolic blood pressure to assess risk and the need for treatment.

Key Words: hypertension • pulse pressure • stroke • coronary heart disease • heart failure • prediction

This article has been cited by other articles:

				J. Blacher, M. E. Safar, C. Vesin, and A. Rudnichi Brachial Pulse Pressure and Cardiovascular Risk Hypertension, November 1, 2007; 50(5): e161 - e161. [Full Text] [PDF]

				W. J. Mosley II, P. Greenland, D. B. Garside, and D. M. Lloyd-Jones Response to Brachial Pulse Pressure and Cardiovascular Risk Hypertension, November 1, 2007; 50(5): e162 - e162. [Full Text] [PDF]