Pulse Pressure and Mortality in Older People

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Abstract
IN MIDDLE-AGED populations, both systolic and diastolic blood pressure have strong, linear relationships with cardiovascular and total mortality.1-5 Because of the high correlation between systolic and diastolic pressure, studies examining cardiovascular risk in this age group commonly find that diastolic pressure provides little additional prognostic information after consideration of systolic pressure.1-4 In older people, however, observational studies have been less consistent6-13 and have commonly found U- or J-shaped relationships of blood pressure with mortality, especially for diastolic pressure. In some studies, individuals with the lowest blood pressure had the highest mortality.14,15 Treatment implications of these relationships remain controversial.16-20 With the loss of aortic compliance, systolic pressure rises with age in industrialized countries, while diastolic pressure declines after about age 60 years, leading to increased pulse pressure and a diminished association between systolic and diastolic pressure.21 This may lead to differing relationships of systolic and diastolic pressure with mortality in older people.