Pulse pressure and cardiovascular risk

Numerous studies have shown that increases in diastolic (DBP) and systolic (SBP) blood pressure are positively associated with cardiac events, Since D BP typically varies by smaller amounts, it has historically been the blood pressure value used most often to assess the risk of cardiovascular disease , Further studies have indicated, however, that SEP continues to increase p roportionally with age, while DBP levels off, New data have emerged which s uggest that DBP can no longer be valued as a reliable predictor of cardiova scular events and may even be diagnostically misleading, Normal levels of D BP can be indicative of a combination of an increase in peripheral vascular resistance (which elevates DBP) with an increase in arterial stiffening (w hich decreases DBP), These two phenomena 'cancel' each other out; the under lying risk factors are disguised by the apparent normalcy of the DBP readin g. DBP is even less of an indicator in older adults, where the prevailing f orm of hypertension is isolated systolic hypertension and the most common c ause is large-artery stiffness, Since arterial stiffening causes SEP to inc rease and DBP to decrease, the gap between the two, pulse pressure (PP), ma y be the best predictor of cardiac events for all the blood pressure values , Several studies have confirmed that subjects with the widest PP have the greatest risk of mortality, Pulse pressure has also been observed to be a s ignificant and independent indicator of myocardial infarction, Furthermore, compelling evidence has emerged that PP is a strong indicator of cardiovas cular risk even among normotensive individuals, J Hypertens 17 (suppl 5):S2 1-S24 (C) 1999 Lippincott Williams & Wilkins.