Implications of pulse pressure as a predictor of cardiac risk in patients with hypertension

Previously we demonstrated that pulse pressure is a strong risk factor for coronary events in male hypertensive subjects in the MRC Mild Hypertension Trial, whereas stroke is best predicted by mean blood pressure. In this stu dy, we have assessed the implications of this finding in the treatment of m ild essential hypertension; We examined the relationship between diastolic blood pressure and both coronary disease risk and stroke when these events were predicted by the above blood pressure measures using an empirical line ar model and multivariate logistic regression models that contained data fr om the MRC trial. Under these circumstances, the predicted stroke risk incr eased progressively with increasing values of diastolic blood pressure, but in both empirical and formal statistical models, the predicted risk of a c oronary event exhibited a I-shaped relationship with diastolic blood pressu re. These results suggest that if coronary event risk in mild essential hyp ertension is predicted by pulse pressure then it may increase at low values of diastolic blood pressure, in contrast to stroke risk, which declines co ntinuously as diastolic blood pressure falls within the physiological range . This raises the possibility that different sequelae of hypertension are b est predicted by different measures of blood pressure and that the effect o f treatment on stroke and coronary events in some circumstances may be disc ordant.