Pulse pressure and risk of cardiovascular events in the systolic hypertension in the elderly program

Pulse pressure has been related to higher risk of cardiovascular events in older persons. isolated systolic hypertension is common among the elderly a nd is accompanied by elevated pulse pressure. Treatment of isolated systoli c hypertension may further increase pulse pressure if diastolic pressure is lowered to a greater extent than systolic pressure. Little is known regard ing pulse pressure as a predictor of cardiovascular outcomes in elderly per sons with isolated systolic hypertension, and the influence of treatment on the pulse pressure effect. We assessed the relation between pulse pressure , measured throughout the follow-up period, and the incidence of coronary h eart disease (CHD), heart failure (HF), and stroke in 4,632 participants in the Systolic Hypertension in the Elderly Program, a 5-year randomized, pla cebo-controlled clinical trial of treatment of isolated systolic hypertensi on in older adults. In the treatment group, a 10-mm Hg increase in pulse pr essure was associated with a statistically significant 32% increase in risk of HF and a 24% increase in risk of stroke after controlling for systolic blood pressure and other known risk factors, as well as with a 23% increase in risk of HF and a 19% increase in risk of stroke after controlling for d iastolic blood pressure and other risk factors. Pulse pressure, was not sig nificantly associated with HF or,stroke in the placebo group, nor with inci dence of CHD in either the placebo or treatment group. These results sugges t that pulse pressure is a useful marker of risk for HF and stroke among ol der adults being treated for isolated systolic hypertension. (C)2001 by Exc erpta Medica, Inc.