Pulse pressure, heart rate, and drug treatment of hypertension.
Peak-systolic blood pressure (SBP) and end-diastolic blood pressure (DBP) have been considered the exclusive mechanical factors predicting cardiovascular (CV) risk in populations of normotensive and hypertensive subjects. The purpose of this review is to show that in addition to SBP and DBP, other hemodynamic indices that have particular relevance for coronary complications and originate from pulse pressure (PP) should be taken into account, namely brachial PP and, potentially, heart rate (HR). In normotensive and hypertensive populations, increased PP is an independent predictor for myocardial infarction, more powerful than SBP, even in hypertensive subjects under successful antihypertensive drug therapy. Increased HR is an additional CV risk factor, acting particularly through the presence of an enhanced PP x HR product. Such findings, observed during a period in which standard antihypertensive agents are known to reduce SBP and PP to a much lesser extent than DBP, require the development of intervention trials using drugs acting specifically on SBP, PP, and arterial stiffness.
Safar
Michel E
ME
Centre de diagnostic, Hôpital Hôtel-Dieu, 1, place du Parvis Notre-Dame, 75181 Paris 04, France. michel.safar@brs.ap-hop-paris.fr
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003971:Diastole / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013599:Systole / Q000187:drug effects
D000959:Antihypertensive Agents