title: Excess mortality associated with increased pulse pressure among middle-aged men and women is explained by high systolic blood pressure.
abstract: OBJECTIVE
  To assess the risk of death from coronary heart disease, stroke, all cardiovascular diseases and all-cause mortality associated with pulse pressure among the middle-aged population.
  
  
  METHODS
  A prospective 15-year follow-up cohort study was conducted of two independent cross-sectional random samples of the population who participated in baseline surveys in 1972 or 1977. Each survey included a self-administered questionnaire with questions on smoking and antihypertensive drug treatment, measurements of height, weight and blood pressure and the determination of the serum cholesterol concentration. Multivariate analyses were performed by using Cox proportional hazard models.
  
  
  METHODS
  The provinces of North Karelia and Kuopio in eastern Finland
  
  
  METHODS
  Men and women aged 45-64 years with no history of myocardial infarction or stroke at the time of the baseline survey were selected. In total 4333 men and 5270 women took part in this follow-up study.
  
  
  RESULTS
  The relative risk of coronary heart disease, stroke, cardiovascular disease and all-cause mortality increased with the increasing pulse pressure in individuals aged 45-64 years independent of the diastolic blood pressure level. Only in women with diastolic blood pressure > or = 95 mmHg was the relative risk of fatal stroke not statistically significant. After adjustment for systolic blood pressure, the positive association between mortality and increasing pulse pressure disappeared.
  
  
  CONCLUSIONS
  Increasing pulse pressure is a predictor of death from coronary heart disease, stroke, cardiovascular disease and all causes in men and women aged 45-64 years, but the increase in risk is entirely associated with the increase in systolic blood pressure.
authors.affiliation: Health Center Hospital of Oulu and Department of Internal Medicine, Oulu University, Finland. Ritta.Antikainen@Ouka.fi
authors.forename: R L
authors.initials: RL
authors.lastname: Antikainen
authors.forename: P
authors.initials: P
authors.lastname: Jousilahti
authors.forename: H
authors.initials: H
authors.lastname: Vanhanen
authors.forename: J
authors.initials: J
authors.lastname: Tuomilehto
mesh_terms: D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology; D015331:Cohort Studies; D003327:Coronary Disease / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011674:Pulse; D012307:Risk Factors; D012727:Sex Characteristics; D020521:Stroke / Q000209:etiology; D013599:Systole