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Pulse Pressure a Better Predictor of Mortality than Mean Blood Pressure
A DGReview of :"Pulsatile blood pressure component as predictor of mortality in hypertension: a meta-analysis of clinical trial control groups"
Journal of Hypertension
01/28/2002
By Mark Greener
Pulse pressure is a better predictor of mortality than mean blood pressure in patients with hypertension.
Current guidelines for management of hypertension are based on systolic and diastolic blood pressure. However, the arterial pressure wave consists of pulsatile component, the pulse pressure, and a steady component, the mean pressure.
Therefore, researchers from the University of Leuven, in Belgium, and centres in Poland, United Kingdom, and France conducted a meta-analysis of seven randomised clinical trials to assess the independent effect of pulse and mean pressures on motality outcomes in a wide range of patients with hypertension.
Individual patient data from control groups of patients with either systolo-diastolic or isolated systolic hypertension were analysed. The authors estimated relative hazard rates and adjusted the subjects in the seven trials for sex, age, smoking, and, as appropriate, pulse or mean pressure.
Results revealed that a 10 mm Hg wider pulse pressure at baseline corresponded to approximately half a standard deviation. This variation was independently associated with a six-percent increased risk for total mortality or death (p=0.001), a seven-percent increased risk for cardiovascular mortality (p=0.01), and a seven-percent increased risk for fatal coronary accidents (p=0.03). The 10 mm Hg wider pulse pressure was also associated a six-percent increased risk for fatal strokes, however, due to the small number of events the difference did not reach statistical significance (p=0.27).
Mean pressure did not independently predict either total or cardiovascular mortality. On the other hand, age significantly interacted with pulse pressure or mean pressure. Pulse pressure better predicted fatal stroke among older people (p=0.04) while mean pressure was a better prognostic factor for coronary mortality among younger people (p=0.01).
The authors concluded that in a wide range of patients with hypertension, pulse pressure, but not mean pressure, is associated with an increased risk for fatal events.
J Hypertens 2002;20:145-151.
"Pulsatile blood pressure component as predictor of mortality in hypertension: a meta-analysis of clinical trial control groups"
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