CLINICAL STUDY: HYPERTENSION
Should diastolic and systolic blood pressure be considered for cardiovascular risk evaluation: a study in middle-aged men and women
Athanase Benetos, MD, PhD*  ,
Frederique Thomas, PhD*,
Michel E. Safar, MD,
Kathryn E. Bean, MA, MPH* and
Louis Guize, MD*
* Centre d’Investigations Préventives et Cliniques (IPC), Paris, France
INSERM U337, Paris, France
Manuscript received March 21, 2000;
revised manuscript received August 9, 2000,
accepted September 26, 2000.
Reprint requests and correspondence: Dr. Athanase Benetos, Centre d’Investigations Préventives et Cliniques (IPC), 6-14 rue de la Pérouse, 75116 Paris, France
benetos{at}ipc.asso.fr
OBJECTIVES
The goal of this study was to evaluate the role of diastolic blood pressure (DBP) in cardiovascular mortality for different systolic blood pressure (SBP) levels in middle-aged men and women.
BACKGROUND
In middle-aged subjects it is unclear whether DBP, in addition to SBP, should be considered for risk evaluation.
METHODS
Subjects (77,023 men; 48,480 women) aged 40 to 70 years old, had no major cardiovascular disease, no antihypertensive treatment and were examined at the Centre d’Investigations Préventives et Cliniques between 1972 and 1988. Mortality was assessed for an 8- to 12-year period.
RESULTS
In both genders, cardiovascular mortality increased with the SBP level. In men and women with normal SBP levels, DBP did not influence cardiovascular mortality after adjustment for age and SBP. In men with systolic hypertension, a U-shaped curve relationship between cardiovascular mortality and DBP was observed, with the lowest mortality rates in the group with DBP 90 to 99 mm Hg. Compared with this group, age- and SBP-adjusted cardiovascular mortality was higher by 73% (p < 0.02) in the group with DBP <90 mm Hg and by 65% (p < 0.001) in the group with DBP  110 mm Hg. In women with systolic hypertension, however, DBP was positively correlated with cardiovascular mortality.
CONCLUSIONS
In middle-aged subjects, classification of cardiovascular risk according to DBP levels should take into account gender, especially when SBP levels are elevated. Men with systolic hypertension are at higher risk when their DBP is "normal" than when they present a mild to moderate increase in DBP. In women of the same age, however, systolic-diastolic hypertension represents a higher risk than isolated systolic hypertension.
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Abbreviations and Acronyms
| | BP | = blood pressure | | CNAM | = Sécurité Sociale (French national health care system) | | DBP | = diastolic blood pressure | | INSEE | = Institut National de Statistiques et d’Etudes Economiques | | INSERM | = National Institute of Medical Research | | IPC Center | = Centre d’Investigations Préventives et Cliniques | | PP | = pulse pressure | | RR | = risk ratio | | SBP | = systolic blood pressure |
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