Role of pulse pressure, systolic blood pressure and diastolic blood pressure, in the prediction of cardiovascular risk.: Cohort study

BACKGROUND AND OBJECTIVE: To analize the role of pulse pressure (PP) systolic (SBP) and diastolic blood pressure (DBP), in the prediction of cardiovascular risk. PATIENS AND METHOD: A prospective cohort study carried out in 2 primary care center, including 932 patients aged between 35-84 years old, without cardiovascular events, selected by simple random sampling, and with an 8 year follow-up. PP, SBP, and DBP were categorized in tertiles, comparing the upper with the 2 lowers. First cardiovascular event, whether fatal or not, such as coronary heart disease cerebrovascular disease, an peripheral arterial disease was recorded as a composite variable. Results were studied according to Cox models adjusting for age sex, smoking, total cholesterol, high density lipoprotein cholesterol, and diabetes mellitus. We studied the correlation between PP with SBP, DBP, and cardiovascular risk factors. RESULTS: We registered 85 cardiovascular events: 43 cases of coronary heart disease, 27 cerebrovascular disease, and 17 peripheral arterial disease. The adjusted hazard ratios for composite variable were: upper PP tertile (>= 59 mmHg) = 1.3 (95% confidence interval [CI] 0.8-2.1); upper SBP tertile (>= 140 mmHg) 1.5 (95% CI, 1.0-2.5); upper DBP tertile (>= 84 mmHg) = 1.1 (95% CI, 0.7-1.8). Results were similar for specific cardiovascular events. PP was correlated with SBP (r = 0.825; p < 0.001), age (r = 0.422; p < 0.001), diabetes mellitus (r = 0.242; p < 0.001), and smoking (r = -0.158; p = 0.01) with adjusted hazard ratio for these variables of 1.0 (95% CI, 0.6-1.9). CONCLUSIONS: PP is an arterial pressure component very correlated with SBP and other factors, but is not a better cardiovascular risk predictor than SBP.