Systolic blood pressure, pulse pressure and arterial stiffness as cardiovascular risk factors

For many years systolic and diastolic blood pressure were the exclusive mechanical factors predicting cardiovascular risk in populations of normotensive and hypertensive individuals. However, if hypertension acts as a mechanical factor with deleterious consequences on the arterial wall, the totality of the blood pressure curve should be considered to evaluate the risk. The purpose of this review is to show that, in addition to systolic and diastolic blood pressure, other haemodynamic indexes with particular relevance for cardiac complications and that originate from pulsatile pressure should be taken into account, namely brachial pulse pressure and aortic pulse wave velocity. The main recent findings in normotensive and hypertensive populations are: (i) increased pulse pressure is an independent predictor of myocardial infarction, congestive heart failure and cardiovascular death, even in hypertensive patients undergoing successful antihypertensive drug therapy; (ii) increased aortic pulse wave velocity and increased carotid incremental elastic modulus are also both independent predictors of cardiovascular mortality, mainly in patients with end-stage renal disease and, to a lesser extent, in individuals with essential hypertension. Currently, increased pulse pressure and increased pulse wave velocity may be considered either as simple markers of an underlying vascular disease or as strong cardiovascular risk factors. The solution of this important question requires the development of specific intervention trials.