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European Heart Journal Advance Access published online on September 1, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi467
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received November 15, 2004
Revised July 6, 2005
Accepted July 28, 2005

Clinical research

Importance of arterial pulse pressure as a predictor of coronary heart disease risk in PROCAM

Gerd Assmann 1*, Paul Cullen 1, Thomas Evers 2, Dieter Petzinna 2, and Helmut Schulte 1

1 Institute of Arteriosclerosis Research at the University of Münster, Münster, Germany
2 Bayer Vital GmbH, Leverkusen, Germany

* To whom correspondence should be addressed.
Gerd Assmann, E-mail: assmann{at}uni-muenster.de


  Abstract

Aims To investigate pulse pressure (PP) as an independent predictor of coronary heart disease (CHD) risk.

Methods and results On the basis of a 10-year follow-up of 5389 men aged 35-65 at recruitment into PROCAM, we used a proportional hazards model to calculate the effect of systolic blood pressure (SBP), diastolic blood pressure (DBP), and PP on CHD risk after correcting for age, high-density lipoprotein cholesterol, LDL cholesterol, triglycerides, smoking, diabetes, and family history of premature CHD. Increases of 10 mmHg in DBP, SBP, and PP were associated with an increased CHD hazard ratio (HR) of ~10%. When the group was divided into the age groups < 50, 50-59, and > 59 years, this relationship was seen in the age group 50-59 years for DBP, SBP, and PP and in men aged ≥ 60 for PP only (25% increase in HR). Overall, CHD risk in men with PP ≥ 70 mmHg was more three times that of men with PP < 50 mmHg. This increased risk was not apparent at age < 50 years, was greatest at age > 60 years, and was also present in men who were normotensive at recruitment (SBP ≤ 160 mmHg, DBP ≤ 95 mmHg).

Conclusion In older European men, increased PP is an important independent determinant of coronary risk, even among those initially considered normotensive.

Keywords: Pulse pressure; Blood pressure; Atherosclerosis; Myocardial infarction; Coronary risk.
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