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.