Risk evaluation and therapeutical implications of pulse pressure in primary arterial hypertension.

Analysis of the results raised in the Framingham and the MRFIT study have clearly shown that increased pulse pressure is an independent cardiovascular risk factor. This is valid for all age groups and both sexes. The risk increases with pulse pressures over 60 - 65 mmHg for office blood pressure and 53 mmHg for 24-h-mean of ambulatory blood pressure. Pulse pressure is strongly correlated with systolic blood pressure and will be highest in case of isolated systolic hypertension. Urinary albumin excretion and left ventricular hypertrophy are closely associated with pulse pressure. With elevated pulse pressure cardiovascular risk is increased 2- to 4-fold in relation to age and endpoint. The risk of myocardial infarction is raised more if pulse pressure is associated with low mean arterial blood pressure while risk of stroke is increased with wide pulse pressure and high mean arterial pressure. The risk of pulse pressure can be seen in normotensives and in early pregnancy. Therapeutic management of pulse pressure will be similar to that of systolic blood pressure, since normalization of systolic blood pressure will also lower or normalize pulse pressure. Results of preliminary studies suggest that diuretics are superior to other drugs in decreasing pulse pressure. An increase of pulse pressure during therapy should be avoided since each 10 mmHg increase in pulse pressure will raise the risk of stroke and myocardial infarction about 24 % and 32 %.