Relative role of systolic, diastolic and pulse pressure as risk factors for cardiovascular events in the Brisighella Heart Study.
OBJECTIVE
The objective of this study was to determine the contribution of elevated blood pressure parameters to the long-term incidence of cardiovascular events.


METHODS
A prospective, population-based longitudinal epidemiological cohort.


METHODS
The population of the town of Brisighella.


METHODS
The Brisighella Heart Study involved 2939 randomly selected residents of Brisighella, Italy aged 14 to 84 years, free of cardiovascular (CV) disease at enrollment and followed since 1972. Subjects were clinically evaluated at baseline and every 4 years following enrollment when extensive clinical and laboratory data were obtained in addition to the assessment of morbidity and mortality.


METHODS
The Cox regression analysis, adjusted for the main risk factors for CV disease was used to determine the independent prognostic significance of systolic, (SBP), diastolic (DBP), and pulse pressure (PP). The events of interest were coronary heart disease (CHD) and cerebrovascular disease (CVD).


RESULTS
Adjusted hazard ratios (HRs) for combined CHD + CVD at SBP categories of 120-139, 140-159, and 159 mmHg were 1.45 [95% confidence interval, (CI), P= 0.035], 1.88 (95% CI, P= 0.0008), and 2.31 (95% CI, P<0.0001), respectively. For DBP ranges of 70-79, 80-89, and 89 mmHg, HRs were 0.91 (95% CI, P= 0.677), 1.33 (95% CI, P= 0.169), and 1.65 (95% CI, P= 0.029), respectively. PP ranges from 54-67 and 67 mmHg were associated with HRs of 1.23 (95% CI, P= 0.149), and 1.38 (95% CI, P= 0.030), respectively. Similar results were seen for CVD and CHD as separate endpoints.


CONCLUSIONS
The present study demonstrates that SBP is a stronger predictor of cardiovascular events than DBP in the Brisighella population. The added prognostic significance of PP is also demonstrated, particularly if PP exceeds 67 mmHg.
Borghi
Claudio
C
Department of Internal Medicine, University of Bologna, Bologna, Italy. claudio@med.unibo.it
Dormi
Ada
A
Ambrosioni
Ettore
E
Gaddi
Antonio
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D003971:Diastole; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011674:Pulse; D012307:Risk Factors; D013599:Systole; D014481:United States / Q000453:epidemiology