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Prognostic Value of Systolic and Diastolic Blood Pressure in Treated Hypertensive Men
Athanase Benetos, MD, PhD;
Frédérique Thomas, PhD;
Kathryn Bean, MA, MPH;
Sylvie Gautier, MD;
Harold Smulyan, MD;
Louis Guize, MD
Arch Intern Med. 2002;162:577-581.
Background The aim of this study was to assess the cardiovascular risk in hypertensive
subjects according to systolic blood pressure (SBP) and diastolic blood pressure
(DBP) levels.
Methods The study sample consisted of 4714 hypertensive men, treated by their
physician, who had a standard health checkup at the d'Investigations Préventives
et Cliniques Center, Paris, France, between 1972 and 1988. Cardiovascular
disease (CVD) and coronary heart disease (CHD) mortality were assessed for
a mean period of 14 years.
Results Among treated subjects, 85.5% presented uncontrolled values for SBP
( 40 mm Hg) and/or DBP (90 mm Hg). After adjustment for age and associated
risk factors, these subjects presented an increased risk for CVD mortality
(risk ratio [RR], 1.66; 95% confidence interval [CI], 1.04-2.64) and for CHD
mortality (RR, 2.35; 95% CI, 1.03-5.35) compared with controlled subjects.
After adjustment for age, associated risk factors, and DBP, and compared with
subjects with SBP under 140 mm Hg, the RR for CVD mortality was 1.81 (95%
CI, 1.04-3.13) in subjects with SBP between 140 and 160 mm Hg and 1.94 (95%
CI, 1.10-3.43) in subjects with SBP over 160 mm Hg. By contrast, after adjustment
for SBP levels, CVD risk was not associated with DBP. Compared with subjects
with DBP under 90 mm Hg, RR for CVD mortality was 1.17 (95% CI, 0.80-1.70)
in subjects with DBP between 90 and 99 mm Hg and 1.03 (95% CI, 0.67-1.56)
in subjects with DBP over 100 mm Hg. Similar results were observed for CHD
mortality.
Conclusions In hypertensive men treated in clinical practice, SBP is a good predictor
of CVD and CHD risk. Diastolic blood pressure, which remains the main criterion
used by most physicians to determine drug efficacy, appears to be of little
value in determining cardiovascular risk. Evaluation of risk in treated individuals
should take SBP rather than DBP values into account.
From the Centre d'Investigations Préventives et Cliniques (Drs
Benetos, Thomas, and Guize and Ms Bean) and Institut de la Santé et
de la Recherche Médicale U337 (Drs Benetos and Gautier), Paris, France;
and Department of Medicine, State University of New York, Upstate Medical
University, New York, NY (Dr Smulyan).
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