ABSTRACT
Introduction Pulse pressure (PP) has been recognized as an independent predictor of cardiovascular risk: (i) in people with established cardiovascular disease (CVD); (ii) in subjects with cardiovascular risk factor, such as hypertension, diabetes mellitus; and (iii) in the general population. Its predictive value seems to increase with age, and in particular in those over 60 years of age, the predictive value of PP is superior to that of systolic blood pressure (SBP), diastolic blood pressure (DBP) or mean arterial pressure (MAP). In terms of haemodynamics, PP measures the ‘pulsatile component’ of BP and can be considered as an indirect marker of arterial stiffness, which is itself an independent predictor of cardiovascular risk, whereas SBP, DBP or MAP measures the ‘steady component’ BP. Whether PP may be considered as a specific mechanical cardiovascular risk factor or as the surrogate of an underlying vascular disease remains unclear. Over 50 years of age, PP may be regarded as a manifestation of arterial stiffness,
Many terms have emerged during 2002, as research interest in PP and arterial stiffness is growing. Data from comparative studies brachial PP vs central (aortic or carotid) PP, clinic PP vs out-of-office PP measure by 24-hour ambulatory BP monitoring or self (home) BP measurement are emerging. Not unexpectedly, 24-hour mean PP is a better predictor for cardiovascular risk than clinic PP. Central (aortic) PP, from a pathophysiological viewpoint being closer to the heart, coronary arteries and carotid arteries, appears to be superior in predicting cardiovascular risk to that measured at the brachial artery. Indeed, aortic PP, but not brachial PP, has been shown to be independently associated with the presence of coronary artery disease (CAD) in patients undergoing coronary angiography, and also to predict the incidence of restenosis after balloon angioplasty. Therefore, recently published studies of antihypertensive drug efficacy have focused on treatment effects not only on BP but also on PP.
