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Pulse Pressure May Be the Best Predictor of Cardiovascular Mortality

  • Authors: News Author: Laurie Barclay, MD
    CME Author:
    Désirée Lie, MD, MSEd
  • CME Released: 10/11/2005
  • Valid for credit through: 10/11/2006
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Target Audience and Goal Statement

This article is intended for primary care physicians, cardiologists, and other specialists who care for patients at risk of CVD.

The goal of this activity is to provide the latest medical news to physicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  • List BP characteristics that predict CVD mortality.
  • Define the risk level for CVD death associated with increases in systolic and diastolic BP and pulse pressure.


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  • Laurie Barclay, MD

    Laurie Barclay is a freelance reviewer and writer for Medscape.


    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.


  • Gary Vogin, MD

    Senior Medical Editor, Medscape


    Disclosure: Gary Vogin, MD, has disclosed no relevant financial relationships.

CME Authors

  • Désirée Lie, MD, MSEd

    Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California


    Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

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Pulse Pressure May Be the Best Predictor of Cardiovascular Mortality

Authors: News Author: Laurie Barclay, MD CME Author: Désirée Lie, MD, MSEdFaculty and Disclosures

CME Released: 10/11/2005

Valid for credit through: 10/11/2006


Oct. 11, 2005 --- Pulse pressure is the best predictor of cardiovascular mortality, according to the results of a prospective cohort study reported in the Oct. 10 issue of the Archives of Internal Medicine.

"Hypertension is a dominant characteristic in the prediction of cardiovascular diseases (CVDs)," write Demosthenes B. Panagiotakos, PhD, from Harokopio University in Athens, Greece, and colleagues from the Seven Countries Study. "The effect of blood pressure [BP] and especially pulse pressure on cardiovascular mortality has rarely been compared among populations."

From 1958 to 1964, 12,763 men, aged 40 to 59 years, from the U.S., Japan, Italy, Greece, former Yugoslavia, Finland, and the Netherlands, were surveyed. Follow-up for vital status and cause of death continued for 25 years.

Compared with age, physical activity, total serum cholesterol level, body mass index, height, and smoking, all baseline BP measurements were the best predictors of CVD mortality. Pulse pressure and diastolic and systolic BPs were the best predictors for CVD death followed by mean and mid BPs.

Differences between cohorts were not significant, with the age-adjusted hazard ratio (HR) per 10-mm Hg increase in pulse pressure varying from 1.19 in the U.S. ( P = .04) to 1.29 in southern Europe ( P = .01). In the pooled cohorts, pulse pressure measurements were also associated with increased risk of coronary heart disease (HR per 10-mm Hg increase, 1.15; P = .04) and of stroke death (HR per 10-mm Hg increase, 1.32; P = .01).

"Pulse pressure followed by diastolic and systolic blood pressures, were the best predictors for CVD mortality among other blood pressures, as well as age, physical activity, total serum cholesterol level, anthropometric indexes, and smoking habits," the authors write. "No significant differences were observed among the different populations studied."

Study limitations include some difficulty in determining the exact cause of death, inclusion only of men, failure to account for risk factor changes during follow-up, use of a single measurement related to long-term prediction of death, problems with standardization of BP measurement in field conditions, and lack of information about serum creatinine levels and sodium intake.

"Blood pressure measurements were significant long-term predictors of CVD death, and despite the high correlation of pulse pressure with systolic blood pressure, pulse pressure predominates in predicting cardiovascular death in middle-aged men," the authors conclude. "Moreover, the relative increase in long-term mortality due to CVD for a given increase in pulse pressure was similar in various populations, whereas the absolute risk at the same level of pulse pressure varied substantially."

The National Heart, Lung, and Blood Institute has disclosed that they funded the Seven Countries Study. The authors have disclosed no relevant financial relationships.

Arch Intern Med. 2005;165:2142-2147