The Relation Between Pulse Pressure and Cardiovascular Mortality in 12 763 Middle-aged Men From Various Parts of the World: A 25-Year Follow-up of the Seven Countries Study | Cardiology | JAMA Internal Medicine | JAMA Network
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Original Investigation
October 10, 2005

The Relation Between Pulse Pressure and Cardiovascular Mortality in 12 763 Middle-aged Men From Various Parts of the World: A 25-Year Follow-up of the Seven Countries Study

Author Affiliations

Author Affiliations: Department of Dietetics and Nutrition, Harokopio University, Athens, Greece (Dr Panagiotakos); National Institute for Public Health and the Environment, Nutrition and Consumer Safety Division, Bilthoven, the Netherlands (Dr Kromhout); Association for Cardiac Research, Rome, Italy (Dr Menotti); Center of Studies of Age-Related Changes in Man, Athens Home for the Aged, Athens (Drs Chrysohoou and Dontas); School of Medicine, University of Athens, Athens (Dr Pitsavos); Kurume University School of Medicine, Third Department of Medicine, Kurume, Japan (Dr Adachi); Division of Epidemiology, University of Minnesota, Minneapolis (Dr Blackburn); Clinical Center of Serbia, University Institute for Cardiovascular Disease, Belgrade, Yugoslavia (Dr Nedeljkovic); and Division of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland (Dr Nissinen).

Arch Intern Med. 2005;165(18):2142-2147. doi:10.1001/archinte.165.18.2142

  This article has been retracted.% See Notice of Retraction and Related Letter.

Background  Hypertension is a dominant characteristic in the prediction of cardiovascular diseases (CVDs). We aimed to evaluate the association of blood pressure measurements with CVD mortality among different populations of the world.

Methods  A total of 12 763 men, aged 40 to 59 years, from 7 countries (United States, Japan, Italy, Greece, former Yugoslavia, Finland, and the Netherlands) were surveyed from 1958 to 1964. Follow-up for vital status and causes of death was carried out over 25 years.

Results  All baseline blood pressure measurements were the best predictors of CVD mortality, compared with age, physical activity, total serum cholesterol level, body mass index or height, and smoking. Moreover, pulse pressure and diastolic and systolic blood pressures were the best predictors for CVD death, followed by mean and mid blood pressures. The age-adjusted hazard ratio per 10–mm Hg increase in pulse pressure varied among cohorts from 1.19 in the United States (P = .04) to 1.29 in southern Europe (P = .01). Differences among cohorts were not significant. In the pooled cohorts, pulse pressure measurements were also a significant predictor for coronary heart disease (hazard ratio per 10–mm Hg increase, 1.15; P = .04) as well as stroke death (hazard ratio per 10–mm Hg increase, 1.32; P = .01).

Conclusions  Pulse pressure followed by diastolic and systolic blood pressures were the best predictors for CVD mortality among other blood pressures, as well as age, physical activity, total serum cholesterol level, anthropometric indexes, and smoking habits. No significant differences were observed among the different populations studied.