Pulse Pressure and Systolic Blood Pressure

Lee, Jae Woo

Abstract

According to the results of the latest Framingham Heart Study, with increasing age, there is a gradual shift from diastolic blood pressure (DBP) to systolic blood pressure (SBP) and then finally to pulse pressure (PP) as predictors of coronary heart disease (CHD) risk. After age 60, DBP was negatively related to CHD risk and PP became superior to SBP as a predictor. A hallmark of the aging process is vascular wall thickening, which is more marked in the central elastic arteries than in the peripheral arteries. Consequently, SBP and PP increase in the central large arteries resulting in a decrease in the pulse amplification between the central and peripheral arteries with increasing age. The PP wave is a summation of an incident wave and a reflected wave, and an earlier return of reflected wave is seen in older subjects due to arterial stiffness and resultant rapid pulse wave velocity (PWV). The major determinant of PWV is age, followed by SBP. In addition to a significant correlation between PWV and various cardiovascular (CV) risk factors, PWV constitutes a marker of atherosclerosis and has been reported as a robust predictor of CV risk and CV mortality. For the treatment of SBP and PP, nitrate, sppironalactone, ACE inhibitor,AngII AT 1 receptor blocker and calcium channel blocker have been shown to be effective in decreasing PWV. Additionally, identifying patients with a genetic polymorphism like the AngII AT 1 receptor gene may be very helpful for specific drug treatments.