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Relation between blood pressure after an acute coronary event and subsequent cardiovascular risk
  1. C-K Wong,
  2. H D White
  1. Cardiovascular Research Unit, Green Lane Hospital, Auckland, New Zealand
  1. Professor Harvey White, Cardiology Department, Green Lane Hospital, Private Bag 92–189, Auckland 1030, New Zealand;
    harveyw{at}adhb.govt.nz

https://doi.org/10.1136/heart.88.6.555

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    Evidence is accumulating that after an acute coronary event, assiduous control of both systolic and diastolic pressure is indicated

    Concepts about the relation between blood pressure and outcomes have evolved over the last 20 years from a sole emphasis on diastolic blood pressure to include both systolic blood pressure1 and pulse pressure.2,3 Recently the Framingham heart study has provided further longitudinal data on the natural evolution of blood pressure over a person’s lifetime.4 The systolic pressure rises linearly between the ages of 30 and 84 years. There is initially a concurrent increase in the diastolic pressure, but between the ages of 50 and 60 years the diastolic pressure begins to decline and the pulse pressure widens steeply.4 It has also been shown that in young subjects the brachial systolic pressure is higher than the central aortic systolic pressure, whereas in older subjects (> 60 years) this difference disappears.5 The explanation for these findings is that there is an age related increase in stiffness accompanied by decreases in the elasticity and compliance of the central conduit arteries, leading to an increased arterial pulse wave velocity and an earlier return of the reflected pressure wave to the aorta.5

    SYSTOLIC PRESSURE AND PULSE PRESSURE ARE THE MAIN RISK FACTORS

    In 2036 subjects aged 50–79 years in the Framingham heart study, only systolic pressure (and not diastolic pressure) was independently associated with the development of coronary heart disease over the subsequent 20 years.6 In patients with systolic pressures of ≥ 120 mm Hg the coronary heart disease risk actually increased as diastolic pressures decreased, suggesting that a wider pulse pressure was an important component of coronary risk.6 A recent report from the Framingham investigators added to this cohort another 4506 subjects from the Framingham offspring study, so that the baseline ages of the combined cohort …

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