Comparison of four blood pressure indexes for the prediction of 10-year stroke risk in middle-aged and older Asians

Information has been sparse on the comparison of 4 blood pressure (BP) indexes (systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP], and mean BP [MBP]) in relation to long-term stroke incidence, especially in middle-aged and older Asian people. A prospective cohort study was performed in 4989 Japanese (1523 men and 3466 women) aged 35 to 79 at baseline with 10 years of follow-up. End points included stroke incidence (total, ischemic, and hemorrhagic). Multivariate-adjusted hazard ratios with a 1-SD higher value for each BP index were determined by Cox proportional hazard analyses; Wald chi2 tests were used to compare the strength of relationships. Analyses were also done for each of 4 age-gender groups consisting of men and women aged 35 to 64 and 65 to 79 years. During follow-up, 132 participants developed stroke. Adjusted hazard ratios for all strokes were 1.68 for SBP, 1.72 for DBP, and 1.80 for MBP, which were higher than that for PP (1.34). SBP and DBP were related positively to stroke risk after adjustment of each other. PP was not the strongest predictor in any age-gender groups among 4 BP indexes. In men aged 65 to 79 years, SBP showed the strongest relationship to all stoke risk (hazard ratio 1.62) among 4 BP indexes. In women aged 65 to 79 years, hazard ratios for all strokes were 2.48 for MBP, 2.46 for DBP, 2.25 for SBP, and 1.57 for PP. The long-term incident stroke risk of high BP in Asians should be assessed by SBP and DBP together, or by MBP, not by PP.     

Predicting stroke using 4 ambulatory blood pressure monitoring-derived blood pressure indices: the Ohasama Study

We investigated the association between stroke and blood pressure (BP) indices (systolic BP [SBP], diastolic BP [DBP], mean BP [MBP], and pulse pressure [PP]) determined by ambulatory BP monitoring. The predictive power for stroke of these indices was compared in the general Japanese population. We obtained ambulatory BP data in 1271 subjects (40% men) aged > or = 40 (mean: 61) years. During a mean follow-up of 11 years, 113 strokes were observed. The multivariate adjusted relative hazard and likelihood ratio for a 1-SD increase for each BP index was determined by Cox proportional hazard regression. Comparison of the likelihood ratio between Cox models including 2 indices and those including 1 index indicated that PP was significantly less informative than other indices (P<0.01 when adding MBP, SBP, or DBP to the PP model; P>0.09 when adding PP to the model including another index). However, after removing age from covariates, PP became more informative than DBP and MBP (P<0.0001 when adding PP to the MBP or DBP model, whereas SBP was more informative than PP even after removing age; P<0.05 when adding SBP to the PP model). In conclusion, PP was the weakest predictor of stroke. Exclusion of age from covariates increased the predictive power of PP, suggesting that the stroke risk associated with PP reflected the risk of aging per se.     

Systolic and diastolic blood pressure, mean arterial pressure and pulse pressure for prediction of cardiovascular events and mortality in a Middle Eastern population

We compared systolic (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP) as independent predictors of cardiovascular disease (CVD), total and CVD mortality among an Iranian population. The study conducted among 5991 subjects aged ≥ 30 years without baseline CVD and antihypertensive medication. The mean of two measurements of SBP and DBP, in sitting position, was considered the subject's blood pressure. During a median follow-up of 8.7 years, 346 CVD and 157 deaths, 63 attributed to CVD, occurred. Hazard ratios (HRs) of each outcome were calculated for a one standard deviation (SD) increase in each blood pressure (BP) measures. In multivariate models, all BP measures were associated with increased risk of CVD regardless of age. In those aged < 60 years, SBP, DBP, PP and MAP were associated with total mortality (p < 0.05), but in subjects aged ≥ 60 years, only SBP and PP increased risk of total mortality significantly. In multivariate analyses, a 1SD increase in SBP, PP and MAP were associated with 35%, 31% and 28% increased risk of CVD mortality (p < 0.05). In terms of fitness and discrimination of models, DBP, PP and MAP were not superior to SBP. In conclusion, our findings provided further evidence from a Middle Eastern population, in support of SBP predictability for CVD events and CVD and all-cause mortality compared with other BP measures.     

Systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in Men

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.     

Pulse pressure predicts cardiovascular risk in patients with type 2 diabetes mellitus

BACKGROUND: Pulse pressure (PP), a marker of arterial stiffness, is a better predictor of coronary heart disease (CHD) risk than systolic blood pressure (SBP) or diastolic blood pressure (DBP) in older adults. Whether this is also true in subjects with type 2 diabetes, who are at increased risk for cardiovascular disease, is unknown. METHODS: Data on 2911 type 2 diabetic subjects relating to blood pressure (BP), other risk factors, and cardiovascular events were abstracted from The Cardiff Diabetes Database. Logistic regression was used to assess the relationship among BP components and the risk of CHD, cerebrovascular (CVD), and peripheral vascular (PVD) events after correction for age, gender, cholesterol, and smoking status. RESULTS: In the 4-year follow-up period there were 574 CHD, 168 CVD, and 157 PVD events. Both PP and SBP, but not DBP, were positively associated with the risk of all event types. However, PP emerged as the best predictor of CHD events, and SBP as the best predictor of CVD and PVD events. Total and HDL-cholesterol were the most important variables associated with PP after age. CONCLUSIONS: In summary, PP is a better predictor of CHD events than SBP in persons with type 2 diabetes, but the converse is true for CVD and PVD.     

Systolic,diastolic, and pulse pressures as coronary risk factors in a population with low cholesterol levels: a prospective 10-year evaluation

BACKGROUND: Pulse pressure (PP) has recently been found to be predictive of subsequent cardiovascular, particularly coronary, events in some middle-aged and elderly populations. HYPOTHESIS: The aim of this prospective population-based study was to evaluate the roles of systolic (SBP), diastolic blood pressure (DBP), and PP in predicting coronary heart disease (CHD) morbidity and mortality in both genders in a population of a wide age span and a setting of low levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol. METHODS: Of participants in the Turkish Adult Risk Factor Study aged > or = 20 years, those free of CHD at baseline examination in 1990 were followed up for a mean of 9.3 years. Coronary heart disease was diagnosed based on clinical findings and Minnesota coding of resting electrocardiograms (ECGs). In 2,601 men and women (mean age at baseline 41.4 +/- 15 years), deaths from CHD developed in 80 and nonfatal CHD in 158 patients. RESULTS: In a logistic regression analysis for predictors of composite endpoint of coronary mortality and morbidity, individually. DBP was not significantly and independently associated, while SBP was an independent risk predictor in both genders (relative risk [RR] 1.016). When two of three blood pressure components were entered jointly into the multivariable model, PP had a value inferior to that of SBP among men and women, but was of greater value than DBP in men in predicting both the composite endpoint and death from CHD. Among women, the predictive values of PP and DBP were similar. Within the categories of SBP > or = 120 mmHg in men, PP contributed significantly to the predictive power of SBP in overall CHD risk over and above that supplied by SBP, whereas DBP remained noncontributory. CONCLUSION: Although inferior to the predictive power of SBP, PP was an important determinant of CHD risk in a population of a diverse age span and a better predictor than DBP in men.     

Blood pressure indices and cardiovascular disease in the Asia Pacific region: a pooled analysis

This article aims to compare the importance of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) as risk factors for stroke and ischemic heart disease and to assess whether the patterns are consistent by age and gender. Cox proportional-hazards regression, adjusted for cholesterol and smoking, was used to assess the associations of the 4 BP indices with stroke and ischemic heart disease by age and gender. The relative importance of individual indices was assessed with a hazard ratios for a 1-SD change in BP and by likelihood-ratio chi2 tests. The influence of >1 BP index in the Cox model was also estimated. The analyses demonstrated similar associations of SBP, DBP, and MAP with both fatal stroke and ischemic heart diseases, which were stronger than those of PP. Both SBP and MAP tended to be more important in the regression model than DBP or PP. In Cox models including DBP, addition of SBP improved the goodness of fit at all ages and for both genders. However, in Cox models including SBP, addition of DBP typically resulted in little incremental benefit over and above that of SBP alone. These data suggest that if time or resources are highly constrained, such as in much-needed epidemiologic surveys in developing countries, very little is lost from only measuring SBP.     

Blood pressure variables and prevalent electrocardiographic left ventricular hypertrophy in sub‐Saharan African individuals with type 2 diabetes

Background: The aim of the present study was to investigate whether brachial blood pressure (BP) variables (systolic BP [SBP], diastolic BP [DBP], pulse [PP] and mean arterial pressure [MAP]) are similar determinants of prevalent electrocardiographic left ventricular hypertrophy (LVH) in sub‐Saharan Africans with type 2 diabetes (T2D). Methods: The study included 420 individuals (49% men) with T2D who were receiving chronic care in two main referral centers in the two major cities (Douala and Yaounde) of Cameroon. Logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals (CI) for a standard deviation (SD) higher level of SBP (25 mmHg), DBP (13), PP (18) and MAP (20) with the risk of LVH. Discrimination was assessed and compared with c‐statistics and relative integrated discrimination improvement (RIDI; %). Results: The multivariable adjusted OR (95% CI) for prevalent LVH with each SD higher pressure variable was 1.61 (1.22–2.11) for SBP, 1.27 (0.99–1.63) for DBP, 1.62 (1.23–2.15) for PP and 1.44 (1.11–1.87) for MAP. Comparison of c‐statistics revealed no difference in the discrimination power of models with each of the BP variables (P > 0.09). However, RIDI showed enhanced discrimination in the models when other BP variables were replaced with PP. However, this enhancement was marginal for SBP. Using BP combinations modestly improved discrimination. Conclusions: The best predictors of prevalent LVH in the present study population were PP and SBP, whereas DBP was the least effective predictor. These findings have implications for cardiovascular risk stratification and monitoring of risk‐reducing therapies.     

Prognostic value of systolic and diastolic blood pressure in treated hypertensive men

BACKGROUND: The aim of this study was to assess the cardiovascular risk in hypertensive subjects according to systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels. METHODS: The study sample consisted of 4714 hypertensive men, treated by their physician, who had a standard health checkup at the d'Investigations Préventives et Cliniques Center, Paris, France, between 1972 and 1988. Cardiovascular disease (CVD) and coronary heart disease (CHD) mortality were assessed for a mean period of 14 years. RESULTS: Among treated subjects, 85.5% presented uncontrolled values for SBP (> or = 40 mm Hg) and/or DBP (> or = 90 mm Hg). After adjustment for age and associated risk factors, these subjects presented an increased risk for CVD mortality (risk ratio [RR], 1.66; 95% confidence interval [CI], 1.04-2.64) and for CHD mortality (RR, 2.35; 95% CI, 1.03-5.35) compared with controlled subjects. After adjustment for age, associated risk factors, and DBP, and compared with subjects with SBP under 140 mm Hg, the RR for CVD mortality was 1.81 (95% CI, 1.04-3.13) in subjects with SBP between 140 and 160 mm Hg and 1.94 (95% CI, 1.10-3.43) in subjects with SBP over 160 mm Hg. By contrast, after adjustment for SBP levels, CVD risk was not associated with DBP. Compared with subjects with DBP under 90 mm Hg, RR for CVD mortality was 1.17 (95% CI, 0.80-1.70) in subjects with DBP between 90 and 99 mm Hg and 1.03 (95% CI, 0.67-1.56) in subjects with DBP over 100 mm Hg. Similar results were observed for CHD mortality. CONCLUSIONS: In hypertensive men treated in clinical practice, SBP is a good predictor of CVD and CHD risk. Diastolic blood pressure, which remains the main criterion used by most physicians to determine drug efficacy, appears to be of little value in determining cardiovascular risk. Evaluation of risk in treated individuals should take SBP rather than DBP values into account.     

Importance of arterial pulse pressure as a predictor of coronary heart disease risk in PROCAM.

AIMS: To investigate pulse pressure (PP) as an independent predictor of coronary heart disease (CHD) risk. METHODS AND RESULTS: On the basis of a 10-year follow-up of 5389 men aged 35-65 at recruitment into PROCAM, we used a proportional hazards model to calculate the effect of systolic blood pressure (SBP), diastolic blood pressure (DBP), and PP on CHD risk after correcting for age, high-density lipoprotein cholesterol, LDL cholesterol, triglycerides, smoking, diabetes, and family history of premature CHD. Increases of 10 mmHg in DBP, SBP, and PP were associated with an increased CHD hazard ratio (HR) of approximately 10%. When the group was divided into the age groups <50, 50-59, and >59 years, this relationship was seen in the age group 50-59 years for DBP, SBP, and PP and in men aged > or =60 for PP only (25% increase in HR). Overall, CHD risk in men with PP > or =70 mmHg was more three times that of men with PP <50 mmHg. This increased risk was not apparent at age <50 years, was greatest at age >60 years, and was also present in men who were normotensive at recruitment (SBP < or =160 mmHg, DBP < or =95 mmHg). CONCLUSION: In older European men, increased PP is an important independent determinant of coronary risk, even among those initially considered normotensive.     

Family history of diabetes modifies the effect of blood pressure for incident diabetes in Middle Eastern women: Tehran Lipid and Glucose Study

Elevated blood pressure (BP) may lead to incident diabetes. However, data about the effect of different BP components on incident diabetes in Middle Eastern women is lacking. We evaluated systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) and mean arterial pressure (MAP) as independent predictors of diabetes in Iranian women. We performed a population-based prospective study among 3028 non-diabetic women, aged ≥20 years. Odds ratios (ORs) of diabetes were calculated for every 1 s.d. increase in SBP, DBP, PP and MAP. During ≈6 years of follow-up, 220 women developed diabetes. There were significant interactions between family history of diabetes and SBP, PP and MAP (P≤0.01) in predicting incident diabetes. In women without a family history of diabetes, all BP components were significantly associated with diabetes in the age-adjusted model; the risk factor-adjusted ORs were significant (P<0.05) for SBP, PP and MAP (1.30, 1.34 and 1.27, respectively) with similar predictive ability (area under the receiver operating characteristic curve ≈83%). In women with family history of diabetes, in the age-adjusted model, SBP, DBP and MAP were associated with diabetes; in multivariable model, they were not independent predictors of diabetes. In conclusion, in women without family history of diabetes, SBP, PP and MAP, were independent predictors of diabetes with almost similar predictive ability; hence, in the evaluation of the risk of BP components for prediction of diabetes, the presence of family history of diabetes should be considered.     

Quantitative study of circadian variations of ambulatory blood pressure in Chinese healthy, hypertensive, and diabetes subjects

Ambulatory blood pressure monitoring (ABPM) recorded abundant data of BP and heart rate (HR) variations with even more derived parameters for evaluation of BP. Using our ABP database system established recently, we studied quantitatively the data of 24-hr ABP in Chinese. First, 155 Chinese were divided into three groups: 50 healthy subjects (C) of 20 men and 30 women, aged 60.0 +/- 10.3 (SD) years; 58 hypertensive patients (H, mild or moderate hypertension) of 33 men and 25 women, aged 59.4 +/- 8.0 years; 47 diabetes patients (D, type 2 diabetes, all were normotensive and with no insulin treatment) with 28 men and 19 women, aged 61.0 +/- 8.5 years. Then 24-hr ABP was monitored by TM-2421 Monitor and data were analyzed by ABP database, cosinor method, and conventional statistics. Our results were 4-fold: 1) systolic BP (SBP), diastolic BP (DBP), HR, rate-pressure product (HR x SBP) showed circadian variations, and significant circadian rhythms were confirmed by cosinor method in all groups. MESOR (midline estimate statistic of rhythm) differed significantly among three groups (H had the highest and C had the lowest values); 2) BP means (SBP, DBP, pulse pressure [PP], and HR x SBP) and BP loads (SBP, DBP, and PP) showed significant differences among the groups (H and D had higher values than that of C); 3) there were no significant differences of BP variability (BPV) of SBP, DBP, and PP among the groups; 4) areas under curve of BP (SBP, DBP, and PP) in H were significantly higher than in C and there was no significant difference between H and D. We concluded that ABPM can offer abundant information on BP evaluation by its direct recording data and derived parameters. The computerized way of treating the large numbers of ABPM values supplies a useful tool in evaluation of BP. Our results suggest that clinically normotensive diabetes patients had some pathological alterations in their BP systems.     

Relationships between blood pressure measurements and target organ damage: Data from the Korea women's chest pain registry

This study was performed to investigate the association between four BP measurements (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], and pulse pressure [PP]) and four TOD parameters (left ventricular mass index [LVMI], E/e′, estimated glomerular filtration rate [eGFR], and obstructive coronary artery disease [CAD]). Data were obtained from a nation‐wide registry, composed of 652 patients (471 women, 58.4 ± 10.5 years) with suspected CAD who underwent elective invasive coronary angiography (CAG). A total of 217 patients (33.2%) had obstructive CAD (≥50%). In multivariable analyses, E/e′ was associated with SBP, MAP and PP, and CAD was associated with SBP and PP (P < 0.05 for each). All four BP measurements were not associated with LVMI and eGFR (P > 0.05 for each). In patients undergoing elective invasive CAG, SBP, and PP had stronger relationships with E/e′ and CAD than DBP and MAP.     

Age,Arterial Stiffness,and Components of Blood Pressure in Chinese Adults

Blood pressure (BP) changes with age. We conducted a cross-sectional study in rural Chinese adults to investigate: (1) what is the relationship between age, arterial stiffness, and BP in Chinese men and women; and (2) to what degree can the age–BP relationship be explained by arterial stiffness, controlling for other covariables.These analyses included a total of 1688 subjects (males/females: 623/1065), aged 40 to 88 years. Among them, 353 (20.9%) had hypertension (defined as systolic blood pressure (SBP) ≥140 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg). Arterial stiffness was measured by brachial–ankle pulse wave velocity (baPWV).baPWV appeared to be more strongly correlated with BP (including SBP, DBP, mean arterial pressure [MAP], pulse pressure [PP]) than age (P < 0.001 for comparisons between Spearman correlation coefficients). Furthermore, baPWV was associated with BP (including SBP, DBP, MAP, and PP) and risk of hypertension in a dose–response fashion, independent of age; in contrast, the age–BP associations were either attenuated or became negative after adjusting for baPWV.Arterial stiffness appears to be an independent contributor to hypertension, even after adjusting for age and other covariables. In contrast, age–BP associations became attenuated or negative after adjusting for baPWV. The utility of baPWV as a diagnostic, prognostic, and therapeutic indicator for hypertension warrants further investigation.     

中老年正常高值血压水平与冠状动脉性心脏病相关

目的探讨中老年正常高值血压人群血压水平与冠状动脉性心脏病(冠心病)的相关性。方法选取316例50岁以上接受冠状动脉造影检查的正常高值血压者,按照冠状动脉造影结果分为冠心病组(n=129)和非冠心病组(n=187)。对所有对象进行血压、身高、体质量测量,检测血脂指标。结果冠心病组舒张压低于非冠心病组[(73.1±8.9)比(77.0±8.0)mmHg],脉压高于非冠心病组[(55.9±10.5)比(51.2±9.5)mmHg]。对性别、年龄等常见冠心病危险因素调整后,较高的收缩压(≥130mmHg)、较低的舒张压(≤85mmHg)以及较大的脉压(≥60mmHg)与冠心病的发生相关,OR(95%CI)分别为1.60(1.04～2.46)、1.52(1.07～2.16)、1.90(1.06～3.39),均P<0.05。多因素Logistic逐步回归分析发现脉压≥60mmHg是冠心病的独立危险因素。结论在中老年正常高值血压人群中,较高的收缩压、较低的舒张压以及脉压增大与冠心病发生风险相关联,脉压≥60mmHg是冠心病的独立危险因素。     

Uric acid and blood pressure in NHANES dated from 2009 to 2018: A cross-sectional research

Background and aimThis study aimed to explore the association between uric acid (UA) and blood pressure (BP), included systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP).Methods and resultsA cross-sectional study with 22,478 individuals aged from 12 to 80 years (11,443 males and 11,035 females) from the National Health and Nutrition Examination Survey (NHANES) was performed. Multiple linear regression analysis was applied to explore the relationship between UA and BP, Stratified analysis and interaction were performed based on gender, race, age, body mass index (BMI), and alcohol consumption. Significantly positively associations were presented in SBP(β, 0.84 [95% CI, 0.67, 1.00]), DBP(β, 0.23 [95% CI, 0.11, 0.36]), and MAP (β, 0.43 [95% CI, 0.31, 0.55]). The associations were much more stronger between UA and SBP in females (β, 1.04 [95% CI, 0.78, 1.30], p for interaction 0.0003), black group (β, 1.17 [95% CI, 0.77, 1.56], p for interaction 0.0296), age (≥45) group (β, 1.03 [95% CI, 0.68, 1.39], p for interaction <0.0001) and drinking group (β, 0.98 [95% CI, 0.75, 1.21], p for interaction <0.0001). The significant interactions were found between UA and DBP in gender and alcohol consumption (all p for interaction <0.05). In terms of MAP, the significant interactions were found in race, age, and alcohol consumption (all p for interaction <0.05).ConclusionsA significantly positively association was found between UA and BP, including SBP, DBP, and MAP.     

Treating blood pressure to prevent strokes: The age factor

The importance of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP), on the incidence of coronary heart disease (CHD) and stroke are known. However, the importance of blood pressure (BP)-age shifts regarding the stroke incidence is not clearly known. The BP changes with the advancement of age from the predominance of DBP in the young to the predominance of SBP in the old. This change is due to the stiffening of the large arteries as a result of the aging process and the replacement of the elastic fibers with collagen fibers. This change results in the loss of compliance and the elastic recoil of these vessels leading to increase in pulse wave velocity, central SBP and widening of pulse pressure leading to an increased incidence of CHD and strokes. It has been demonstrated epidemiologically that the SBP rises linearly with age, whereas the DBP rises up to the age of 45-50 years, and then begins to decline after the age of 60 years leading to a progressive widening of PP. Several studies have shown an inverse relationship between DBP and CHD, whereas no such relationship has been demonstrated for stroke. However, a recent study showed an inverse relationship with DBP and stroke when it dropped below 71 mmHg in subjects 50 years of age or older. In contrast, there was a positive association between BP and stroke when both SBP and DBP were ≥ 71 mmHg. These findings suggest that intreating systolic hypertension in the elderly to reduce stroke risk, attention should be paid on the potential harm of low DBP and the widening of PP regarding CHD and stroke. The implications of BP shifts with age and the potential risks of low DBP regarding the risk of stroke will be discussed in this concise review.     

Influence of height,leg and trunk length on pulse pressure,systolic and diastolic blood pressure

OBJECTIVE: To compare the effects of height, leg and trunk length on pulse pressure (PP), systolic (SBP) and diastolic blood pressure (DBP) in men and women. DESIGN: Prospective, population-based, birth cohort study. SETTING: England, Scotland and Wales. PARTICIPANTS: A total of 1472 men and 1563 women aged 53 years and followed since their birth in 1946. MAIN OUTCOME MEASURES: PP, SBP and DBP at age 53 years. RESULTS: PP increased linearly with decreasing height and leg length in men and women [shortest compared with the tallest height (leg length) group, men 54.6 versus 51.0 mmHg (55.8 versus 50.7 mmHg), women 52.9 versus 48.4 mmHg (53.3 versus 48.6 mmHg); P for trend < or = 0.001 in each case]. Adjustment for adult confounding factors and childhood social class or birth weight only slightly weakened these results (P for trend < or = 0.01 in each case). SBP, but not DBP, showed similar but weaker trends in men and women, except for the association with height in men, which lost statistical significance after adjustment. Trunk length was not associated with any outcome measure in men or women. CONCLUSIONS: Short height and leg length are associated with increased PP and SBP, but not DBP, in middle-aged men and women. PP is a potential mediator between short height and leg length and increased risk of coronary heart disease. Future studies of the association between shortness and coronary heart disease should consider the role of arterial hemodynamics.     

Blood pressure and risk of cardiovascular diseases in type 2 diabetes: further findings from the Swedish National Diabetes Register (NDR-BP II)

OBJECTIVES:: Estimate risks of coronary heart disease (CHD), stroke and cardiovascular disease (CVD) with updated mean systolic (SBP) and diastolic (DBP) blood pressure in an observational study of patients with type 2 diabetes. METHODS:: Thirty-five thousand and forty-one patients treated with antihypertensive drugs, and 18?512 untreated patients, aged 30-75 years, without previous heart failure, followed for 6 years until 2009. RESULTS:: In treated patients, nonlinear splines for 6-year risk of fatal/nonfatal CHD, stroke and CVD by BP as a continuous variable showed a progressive increase with higher SBP from 140?mmHg and higher, and with DBP from 80?mmHg, with a J-shaped risk curve at lowest SBP levels, but not obviously at lowest DBP levels. Analysing intervals of SBP with 130-134?mmHg as reference at Cox regression, adjusted hazard ratios (HR) for fatal/nonfatal CHD, stroke and CVD with at least 140?mmHg were 1.22 [95% confidence interval (CI): 1.08-1.39], 1.43 (1.18-1.72), 1.26 (1.13-1.41), all P?相似文献   

Pulse pressure and risk for myocardial infarction and heart failure in the elderly

OBJECTIVES: We sought to determine whether pulse pressure (PP), a measure of arterial stiffness, is an independent predictor of the incidence of coronary heart disease (CHD), congestive heart failure (CHF) and overall mortality among community-dwelling elderly. BACKGROUND: Current hypertension guidelines classify cardiovascular risk on the basis of elevated systolic blood pressure (SBP) or diastolic blood pressure (DBP) without considering their combined effects. Recent studies suggest that PP is a strong predictor of cardiovascular end points, but few data are available among community elderly. METHODS: The study sample included 2,152 individuals age > or =65 years, who were participants in the Established Populations for Epidemiologic Study of the Elderly program, free of CHD and CHF at baseline and still alive at one year after enrollment. Blood pressure was measured at baseline. Incidence of CHD, incidence of CHF and total mortality were monitored in the following 10 years. RESULTS: There were 328 incident CHD events, 224 incident CHF events and 1,046 persons who died of any cause. Pulse pressure showed a strong and linear relationship with each end point. After adjusting for demographics, comorbidity and CHD risk factors, a 10-mm Hg increment in PP was associated with a 12% increase in CHD risk (95% confidence interval [CI], 2% to 22%), a 14% increase in CHF risk (95% CI, 5% to 24%), and a 6% increase in overall mortality (95% CI, 0% to 12%). While SBP and mean arterial pressure (MAP) also showed positive associations with the end points, PP yielded the highest likelihood ratio chi-square. When PP was entered in the model in conjunction with other blood pressure parameters (SBP, DBP, MAP or hypertension stage, respectively), the association remained positive for PP but became negative for the other blood pressure variables. The effect of PP persisted after adjusting for current medication use and was present in normotensive individuals and individuals with isolated systolic hypertension but not in individuals with diastolic hypertension. CONCLUSIONS: Elevated PP is a powerful independent predictor of cardiovascular end points in the elderly.