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ARTICLE

Systolic Blood Pressure, Diastolic Blood Pressure, and Pulse Pressure as Predictors of Risk for Congestive Heart Failure in the Framingham Heart Study

Agha W. Haider, MD, PhD; Martin G. Larson, ScD; Stanley S. Franklin, MD; and Daniel Levy, MD

7 January 2003 | Volume 138 Issue 1 | Pages 10-16

Background: Although hypertension is a principal precursor of congestive heart failure (CHF), the separate relations of systolic, diastolic, and pulse pressure with risk for heart failure have not been fully elucidated.

Objective: To examine the value of blood pressure predictors of heart failure.

Design: Community-based inception cohort study.

Setting: Framingham, Massachusetts.

Patients: 2040 free-living Framingham Heart Study participants (mean age, 61 years [range, 50 to 79 years]).

Measurements: The association of baseline systolic, diastolic, and pulse pressure with risk for incident CHF was examined in 894 men and 1146 women. Framingham Heart Study participants free of CHF at the baseline examination (performed from 1968 to 1973) were monitored for up to 24 years (mean, 17.4 years) for new-onset heart failure. Cox proportional-hazards models were used to adjust for age, sex, smoking, left ventricular hypertrophy, body mass index, diabetes mellitus, high-density lipoprotein cholesterol level, and heart rate; hazard ratios and 95% CIs for blood pressure variables were estimated.

Results: CHF developed in 234 participants (11.8%) during the follow-up period. All three blood pressure components were related to the risk for CHF, but the relation was strongest for systolic and pulse pressure. A 1-SD (20 mm Hg) increment in systolic pressure conferred a 56% increased risk for CHF (hazard ratio, 1.56 [95% CI, 1.37 to 1.77]); similarly, a 1-SD (16 mm Hg) increment in pulse pressure conferred a 55% increased risk for CHF (hazard ratio, 1.55 [CI, 1.37 to 1.75]). These associations were unrelated to age, duration of follow-up, and initiation of treatment for hypertension during follow-up; they were also observed in patients with systolic hypertension (systolic blood pressure 140 mm Hg) at the baseline examination (hazard ratio, 1.41 [CI, 1.18 to 1.69] for pulse pressure and 1.42 [CI, 1.14 to 1.76] for systolic pressure).

Conclusions: Although each component of blood pressure was associated with risk for CHF, pulse and systolic pressure conferred greater risk than diastolic pressure. Increased pulse pressure may help identify hypertensive patients at high risk for overt CHF who are candidates for aggressive blood pressure control.

Editors' Notes Context Hypertension is a recognized risk factor for the development of congestive heart failure (CHF). By measuring blood pressure, however, we have not yet been able to understand the significance of pulse pressure as a contributor to CHF in middle-aged men and women. Contribution Using data from the Framingham Heart Study, the authors found that although elevations of systolic, diastolic, and pulse pressure were all related to the risk for CHF, the relation was strongest for systolic and pulse pressure. Cautions Understanding the relationships between systolic, diastolic, and pulse pressure and risk for CHF is helpful; however, they do not help determine the increased risk faced by a person with systolic hypertension who also has increased pulse pressure. –The Editors

 

Author and Article Information

From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; Boston University School of Medicine and Beth Israel Deaconess Medical Center, Boston, Massachusetts; University of California, Irvine, Irvine, California; Veterans Administration Medical Center, West Roxbury, Massachusetts; and MCP Hahnemann University Hospital, Philadelphia, Pennsylvania.

Grant Support: By contract N01-HC-38038 from the National Heart, Lung, and Blood Institute, National Institutes of Health. Dr. Haider's fellowship was supported in part by a grant from AstraZeneca Pharmaceuticals, Wayne, Pennsylvania.

Requests for Single Reprints: Daniel Levy, MD, Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, MA 01702-5827.

Current Author Addresses: Dr. Haider: Cardiology Department, Drexel University College of Medicine, 3300 Henry Avenue, Philadelphia, PA 19129.

Dr. Franklin: University of California, Irvine, CA 92697.

Drs. Larson and Levy: Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, MA 01702-5827.

Author Contributions: Conception and design: A.W. Haider, M.G. Larson, S.S. Franklin, D. Levy.

Analysis and interpretation of the data: A.W. Haider, M.G. Larson, D. Levy.

Drafting of the article: A.W. Haider, D. Levy.

Critical revision of the article for important intellectual content: A.W. Haider, M.G. Larson, D. Levy.

Final approval of the article: A.W. Haider, M.G. Larson, S.S. Franklin, D. Levy.

Obtaining of funding: A.W. Haider.

Statistical expertise: M.G. Larson.

Collection and assembly of data: M.G. Larson.

Related articles in Annals:

Summaries for Patients
Evaluation of Risk Factors for Congestive Heart Failure

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