Pulse pressure compared with other blood pressure indexes in the prediction of 25-year cardiovascular and all-cause mortality rates - The Chicago Heart Association detection Project in Industry Study

We compared the relations of 4 blood pressure (BP) indexes (pulse pressure [PP], systolic BP [SBP], diastolic BP [DBP], and mean arterial pressure [MA P]) with 25-year mortality rates for coronary heart disease (CHD), cardiova scular disease (CVD), and all causes in younger, middle-aged, and older men and women by using data from a long-term prospective epidemiological study of employed persons who were screened between 1967 and 1973. A single supi ne BP measurement was obtained at baseline. Vital status was determined thr ough 1995. We report on 5 groups (total, 28 360 participants) consisting of men age 18 to 39, 40 to 59, and 60 to 74 years and of women age 40 to 59 a nd 60 to 74 years who were not receiving antihypertensive treatment, had no history of CHD, and did not have diabetes. Cox proportional hazards analys es were used to determine multivariate-adjusted hazard ratios with a 1-SD h igher value for each BP index; Wald chi (2) tests were used to compare the strength of relations. Relations of PP were less strong than were those of SBP for all end points in all age/gender groups. SBP or MAP showed the stro ngest relations to all end points in all age/gender groups (hazard ratio, 1 .17 to 1.36). The relations of SBP to death were stronger than were those o f DBP, except for middle-aged men and for CVD in women. DBP showed signific ant positive associations with death, after control for SBP, in middle-aged participants. In conclusion, these data indicate that the long-term risk o f high BP should be assessed mainly on the basis of SBP or of SBP and DBP t ogether, not on the basis of PP, in apparently healthy adults.