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

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 similar to 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.