Systolic and Diastolic Blood Pressure, Pulse Pressure, and Mean Arterial Pressure as Predictors of Cardiovascular Disease Risk in Men

Abstract

We compared systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP) in predicting the risk of cardiovascular disease (CVD), stratifying results at age 60 years, when DBP decreases while SEP continues to increase. We prospectively followed 11150 male physicians with no history of CVD or antihypertensive treatment through the 2-year questionnaire, after which follow-up began. Reported blood pressure was averaged from both the baseline and 2-year questionnaires. During a median follow-up of 10.8 years, there were 905 cases of incident CVD. For men aged <60 years (n = 8743), those in the highest versus lowest quartiles of average SEP (<greater than or equal to>130 versus <116 mm Hg), DBP (<greater than or equal to>81 versus <73 mm Hg), and MAP (<greater than or equal to>97 versus <88 mm Hg) had relative risks (RRs) of CVD of 2.16, 2.23, and 2.52, respectively. Models with average MAP and PP did not add information compared with models with MAP alone (P > 0.05). For men aged greater than or equal to 60 years (n = 2407), those in the highest versus lowest quartiles of average SEP (greater than or equal to 135 versus <120 mm Hg), PP (<greater than or equal to>55 versus <44 mm Hg), and MAP (<greater than or equal to>99 versus <91 mm Hg) had RRs of CVD of 1.69, 1.83, and 1.43, respectively. The addition of other blood pressure measures did not add information compared with average SEP or PP alone (all P > 0.05). These data suggest that average SEP, DBP, and MAP strongly predict CVD among younger men, whereas either average SEP or PP predicts CVD among older men. More research should distinguish whether MAP, highly correlated with SEP and DBP, better predicts CVD.