Comparison of usefulness of systolic, diastolic, and mean blood pressure and pulse pressure as predictors of cardiovascular death in patients ≥60 years of age (The Dubbo Study)

Abstract

Blood pressure (BP) is an important predictor of future cardiovascular risk. Clinicians have traditionally recognized the importance of systolic BP, especially in older adults. 1 BP is also characterized by its pulsatile (estimated by pulse pressure [PP]) and steady (estimated by mean arterial pressure) components. 2 Two recent studies 3,4 have emphasized the importance of PP, defined as systolic BP minus diastolic BP, as a predictor of cardiovascular events or mortality in the elderly. Another study 5 highlighted mean BP, defined as 1/3 systolic BP plus 2/3 diastolic BP, as a predictor of cardiovascular disease risk. Data from the Framingham Heart Study 6 and other studies 7 indicate that systolic BP increases continuously with age, whereas diastolic BP increases until age 60 years and then begins to decrease steadily. As a result, PP may become a more important BP measurement associated with cardiovascular disease in older persons. 8 Darne et al 2 were among the first to report that PP, in addition to mean BP, was an independent cardiovascular risk factor. Mean BP has not been as extensively studied, with positive associations with cardiovascular disease in some 5,9,10 but not all 11 studies. It remains unclear which measures of BP, either alone or in combination, best predict the risk of cardiovascular disease mortality. Therefore, we studied the use of systolic BP, diastolic BP, PP, and mean BP in an elderly cohort of men and women aged ≥60 years at baseline with no history of cardiovascular disease. Using BP values at baseline, we compared the associations of each BP measure with the risk of cardiovascular disease mortality prospectively over 12 to 13 years of follow-up.The Dubbo Study is an ongoing prospective study in an elderly Australian cohort first examined in 1988. 12 All noninstitutionalized residents of the semi-urban town of Dubbo, New South Wales, born before 1930 were eligible; the participation rate was 73%, with an ultimate cohort of 2,805 men and women. Methods and measures have already been described in detail. 12 Briefly, the baseline examinations consisted of demographic, psychosocial, and standard cardiovascular risk assessment. Two BP readings were obtained after 10 minutes of seated rest, using phase V as diastolic. The second of these 2 readings was used in the present analyses. The study was approved and reapproved by institutional ethics committees at St. Vincent's Hospital Sydney, the University of New South Wales (Sydney, Australia), and the Australian National University (Canberra, Australia). All participants gave written informed consent. NIH Public Access Author ManuscriptAm J Cardiol. Author manuscript; available in PMC 2011 July 1. Outcomes until September 2001 are included in the present analysis. Hospitalization and death records were monitored continuously, and postal surveys were conducted every 2 years to confirm vital status. The most recent survey successfully traced >95% of the surviving participants. Records were coded according to the International Classification o...

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“…Mean blood pressure, defined as 1/3 systolic blood pressure + 2/3 diastolic blood pressure, was calculated for each participant's average reading. This measure of blood pressure has been shown to predict cardiovascular disease and death and may be the best predictor of these health outcomes when single blood pressure parameters are used [ 75 ]. In addition to these blood pressure measurements, participants were asked whether they were currently taking blood pressure medication.…”

<p>A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients</p>

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“…In many studies, SBP has been superior to DBP when assessing CV risk, 1,4,8,14,22–28 but in JNC 7 both SBP and DBP are used to determine risk status. In our study, SBP alone predicted risk of CVD death, and DBP did not add prognostic information within the JNC 7 classification system.…”