Pulse Pressure Not Mean Pressure Determines Cardiovascular Risk in Older Hypertensive Patients

Abstract

ARTERIAL HYPERTENSION mechanically stresses the endothelium and the deeper layers of the arterial wall. The ensuing arterial lesions lead in the long run to debilitating and lethal complications, in particular stroke and myocardial infarction. The current guidelines for the management of hypertension rest almost completely on the measurement of systolic and diastolic blood pressure, 2 specific inflection points of the blood pressure wave, which are usually considered in isolation.^1,2 However, blood pressure propagates through the arterial tree as a repetitive continuous wave and is more accurately described as consisting of a pulsatile component (pulse pressure) and a steady component (mean pressure).³ The former depends on ventricular ejection, arterial stiffness, and the timing of wave reflections, whereas cardiac output and peripheral vascular resistance are the major determinants of mean pressure.