1. Circulation. 2009 Jan 20;119(2):243-50. Epub 2008 Dec 31.

Single versus combined blood pressure components and risk for cardiovascular
disease: the Framingham Heart Study.

Franklin SS, Lopez VA, Wong ND, Mitchell GF, Larson MG, Vasan RS, Levy D.

Heart Disease Prevention Program, Department of Medicine, C240 Medical Sciences, 
University of California, Irvine, CA 92697, USA. ssfranklinmd@earthlink.net

Comment in:
    Circulation. 2009 Jan 20;119(2):210-2.

BACKGROUND: The utility of single versus combined blood pressure (BP) components 
in predicting cardiovascular disease (CVD) events is not established. We compared
systolic BP (SBP) and diastolic BP (DBP) versus pulse pressure (PP) and mean
arterial pressure (MAP) combined and each of these 4 BP components alone in
predicting CVD events. METHODS AND RESULTS: In participants in the original
(n=4760) and offspring (n=4897) Framingham Heart Study who were free of CVD
events and BP-lowering therapy, 1439 CVD events occurred over serial 4-year
intervals from 1952 to 2001. In pooled logistic regression with the use of BP
categories, combining SBP with DBP and PP with MAP improved model fit compared
with individual BP components (P<0.05 to P<0.0001). Significant interactions were
noted between SBP and DBP (P=0.02) and between PP and MAP (P=0.01) in their
respective multivariable models. Models with continuous variables for SBP+DBP and
PP+MAP proved identical in predicting CVD events (Akaike Information Criteria=10 
625 for both). Addition of a quadratic DBP(2) term to DBP and SBP further
improved fit (P=0.0016). CONCLUSIONS: Combining PP with MAP and SBP with DBP
produced models that were superior to single BP components for predicting CVD,
and the extent of CVD risk varied with the level of each BP component. The
combination of PP+MAP (unlike SBP+DBP) has a monotonic relation with risk and may
provide greater insight into hemodynamics of altered arterial stiffness versus
impaired peripheral resistance but is not superior to SBP+DBP in predicting CVD

PMID: 19118251 [PubMed - indexed for MEDLINE]