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January 8, 2003

Pulse Pressure and Risk of Cardiovascular Disease

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(2):174-175. doi:10.1001/jama.289.2.174-a

To the Editor: Dr Domanski and colleagues1 present 2 analyses of the relationship between blood pressure and cardiovascular disease–related mortality. Unfortunately their results are contradictory. The first analysis, which uses linear regression, finds that increasing systolic blood pressure (SBP) and increasing diastolic blood pressure (DBP) are both related to increasing risk of mortality. The second analysis, illustrated by their Figure, is by groupings into strata of blood pressure. This shows a relation in which risk can increase with both low and high DBP. This is inconsistent with a linear relationship implied by the regression analysis. Such an analysis seems to be used only to provide statistical "proof" that both SBP and DBP provides better prediction than either alone. But in their discussion the authors make this point by using the conflicting results from the categorical analysis showing risks can rise with both low and high DBP. The relationships determined by the 2 analyses cannot both be correct.

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