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
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.153.100.128. Please contact the publisher to request reinstatement.
1.
Burt  VLWhelton  PRoccella  EJ  et al.  Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey 1988-99.  Hypertension 1995;25305- 313PubMedGoogle ScholarCrossref
2.
Chobanian  AVBakris  GLBlack  HR  et al. National High Blood Pressure Education Program Coordinating Committee, The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.  JAMA 2003;2892560- 2572PubMedGoogle ScholarCrossref
3.
Working Group on Primary Prevention of Hypertension, National High Blood Pressure Education Program Working Group report on primary prevention of hypertension.  Arch Intern Med 1993;15386- 208PubMedGoogle Scholar
4.
van den Hoogen  PCFeskens  EJNagelkerke  NJMenotti  ANissinen  AKromhout  D The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world.  N Engl J Med 2000;3421- 8PubMedGoogle ScholarCrossref
5.
Palmer  ABulpitt  CBeevers  G  et al.  Risk factors for ischemic heart disease and stroke mortality in young and old hypertensive patients.  J Hum Hypertens 1995;9695- 697PubMedGoogle Scholar
6.
Lopez  ADMurray  CC The global burden of disease, 1990-2020.  Nat Med 1998;41241- 1243PubMedGoogle ScholarCrossref
7.
Franklin  SSKhan  SAWong  NDLarson  MGLevy  D Is pulse pressure useful in predicting risk for coronary heart disease? the Framingham Heart Study.  Circulation 1999;100354- 360PubMedGoogle ScholarCrossref
8.
Benetos  ASafar  MRudnichi  A  et al.  Pulse pressure: a predictor of long-term cardiovascular mortality in a French male population.  Hypertension 1997;301410- 1415PubMedGoogle ScholarCrossref
9.
Benetos  A Pulse pressure and cardiovascular risk.  J Hypertens Suppl 1999;17S21- S24PubMedGoogle ScholarCrossref
10.
Domanski  MMitchell  GPfeffer  M  et al. MRFIT Research Group, Pulse pressure and cardiovascular disease-related mortality: follow-up study of the Multiple Risk Factor Intervention Trial (MRFIT).  JAMA 2002;2872677- 2683PubMedGoogle ScholarCrossref
11.
Keys  A Coronary heart disease in seven countries: American Heart Association Monograph 29.  Circulation 1970;41 ((suppl 1)) 1- 211Google ScholarCrossref
12.
Anderson  JTKeys  A Serum cholesterol in serum and lipoprotein fractions: its measurement and stability.  Clin Chem 1956;2145- 159PubMedGoogle Scholar
13.
Menotti  ASeccareccia  F Risk factors and mortality patterns in the Seven Countries Study. Toshima  HKoga  YBlackburn  Heds Lessons for Science From the Seven Countries Study. Tokyo, Japan Springer-Verlag Tokyo1994;17- 34Google Scholar
14.
Menotti  ABlackburn  HKromhout  DNissinen  AAdachi  HLanti  MSeven Countries Study Research Group, Cardiovascular risk factors as determinants of 25-year all-cause mortality in the Seven Countries Study.  Eur J Epidemiol 2001;17337- 346PubMedGoogle ScholarCrossref
15.
Menotti  AKeys  ABlackburn  H  et al.  Comparison of multivariate predictive power of major risk factors for coronary heart disease in different countries: results from eight nations of the Seven Countries Study, 25-year follow-up.  J Cardiovasc Risk 1996;369- 75PubMedGoogle ScholarCrossref
16.
Menotti  AJacobs  DR  JrBlackburn  H  et al.  Twenty-five-year prediction of stroke deaths in the seven countries study: the role of blood pressure and its changes.  Stroke 1996;27381- 387PubMedGoogle ScholarCrossref
17.
O’Rourke  M Mechanical principles in arterial disease.  Hypertension 1995;262- 9PubMedGoogle ScholarCrossref
18.
Christensen  KL Reducing pulse pressure in hypertension may normalize small artery structure.  Hypertension 1991;18722- 727PubMedGoogle ScholarCrossref
19.
Lewington  SClarke  RQizilbash  NPeto  RCollins  RProspective Studies Collaboration, Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.  Lancet 2002;3601903- 1913PubMedGoogle ScholarCrossref
20.
Kawasaki  TSasayama  SYagi  SAsakawa  THirai  T Noninvasive assessment of age related changes in stiffness of major branches of the human arteries.  Cardiovasc Res 1987;612- 30Google Scholar
21.
Benetos  ALaurent  SHoeks  APBoutouyrie  PHSafar  ME Arterial alterations with aging and high blood pressure.  Arterioscler Thromb 1993;1390- 97PubMedGoogle ScholarCrossref
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
Abstract

  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.

×