Cautionary Note on the Use of Pulse Pressure as a Risk Factor for Coronary Heart Disease

To the Editor:Dr Franklin and others have reported a number of important findings from the Framingham data set. In the latest article, 1 the authors have concluded that, among systolic, diastolic, and pulse pressures, pulse pressure is the strongest predictor of coronary heart disease (CHD) in persons 60 years of age and older. However, the relative importance of various blood pressure measures as predictors for CHD risk is not, in our opinion, tested properly. We believe that the statistical analyses comparing different measures of blood pressure are flawed in this and other studies. 2–4A common means of comparing different blood pressures for CHD prediction is to examine the relative risk (RR) or hazard ratio (HR) of a CHD event that would result from a change of 10 mm Hg in each pressure measure. 1–4 However, comparing risks or hazards of two different continuous measures is only valid if the amount of change in one measure is comparable …