A new model of risk: implications of increasing pulse pressure and systolic blood pressure on cardiovascular disease

Diastolic blood pressure (DBP) has historically functioned as the primary indicator of cardiovascular disease (CVD). Many clinical and observational, long-term, large population studies, including the Framingham Heart Study and Multiple Risk Factor Intervention Trial (MRFIT), have repeatedly demonstrated a positive correlation between CVD events and DBP. However, unexplained results, often emerged from the data, in the form of a DBP threshold (where lower rates of DBP were not associated with lower disease rates) and a J-shaped relationship (a decline of DBP that correlated with an increased risk of CVD), have complicated the association of blood pressure to events. In the past decade studies have focused on other indicators to explain these irregularities. From these clinical and observational studies, new evidence has become available which strongly indicates that systolic blood pressure (SBP) and pulse pressure (PP) may be more reliable predictors of CVD events than DBP. Indeed, in several studies, a wide baseline PP has been identified as the only measure of blood pressure that is an independent risk factor for cardiac events, Moreover, pretreatment SEP has linearly predicted future CVD events in treated patients, while DBP has not. These studies of treated patients have also led to the identification of pretreatment risk factors that can be applied to stratify risk among patients who go on to have controlled blood pressure on treatment. This new information can more precisely identify patients at increased risk of CVD events and thus make it possible to more precisely tailor therapy to enhance the potential for CVD prevention. J Hypertens 17 (suppl 5):S25-S28 (C) 1999 Lippincott Williams & Wilkins.