How Important Is Pulse Pressure as a Predictor of Cardiovascular Risk?

To the Editor:Miura and colleagues1 report that pulse pressure (PP) is of no added value to systolic blood pressure (SBP) in assessing long-term cardiovascular (CV) mortality in 60- to 74-year-old men and women volunteers from 84 cooperating Chicago-area companies and organizations.In contrast, we published a Framingham Heart Study report that found coronary heart disease (CHD) risk in middle-aged and older individuals to be inversely related to diastolic blood pressure (DBP) at any given level of SBP ≥130 mm Hg (Franklin et al, 1999, Table 4),2 suggesting that PP may be superior to SBP as a predictor of risk in this older population. We would like to consider some of the explanations for the different results reported in our paper and that of Miura et al.First, numerous longitudinal and cross-sectional studies of age-related changes in blood pressure have shown that mean DBP levels off by about age 50 years and begins to decrease by the age of 60 years.3–5 Contrary to these findings, the Miura study shows a rise in DBP from age 40 to 59 versus age 60 to 74 in men (83.5 versus 85.8 mm Hg) and in women (79.5 versus 82.3 mm Hg), suggesting that the Chicago-area volunteer workers population may not be typical of many other populations in the United States and around the world.Second, Miura et al state correctly that the proper approach in assessing the value of PP is to place both SBP and DBP in the same Cox model, and only if DBP has an inverse relation to CV mortality can PP be shown superior to SBP. This inverse relation of …