Outcome-Driven Thresholds for Pulse Pressure on Office and Out-of-the-Office Blood Pressure Measurement

  • Yumei Gu
  • Lucas S. Aparicio
  • Yanping Liu
  • Kei Asayama
  • Tine W. Hansen
  • Teemu J. Niiranen
  • José Boggia
  • Lutgarde Thijs
  • Jan A. StaessenEmail author


Longitudinal studies demonstrated that the risk of cardiovascular disease increased with pulse pressure (PP). However, PP remains an elusive cardiovascular risk factor with findings being inconsistent between studies. The 2013 ESH/ESC guideline proposed that PP is useful in stratification and suggested 60 mmHg as threshold, moving it up to by 10 mmHg compared with the 2007 guideline without providing any justification. Published thresholds of PP are based on office blood pressure measurement and often on arbitrary categorical analyses. In the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) and in the International Database on Home blood pressure in relation to Cardiovascular Outcome (IDHOCO), we determined outcome-driven thresholds for PP based on ambulatory or home blood pressure measurement, respectively. The main findings are that below age 60 PP does not refine risk stratification, whereas in older people the thresholds were 64 and 76 mmHg for the ambulatory and home PP, respectively. However, PP provided little added predictive value over and beyond classical risk factors.


Pulse pressure Thresholds Blood pressure measurement Epidemiology Cardiovascular diseases 


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Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Yumei Gu
    • 1
  • Lucas S. Aparicio
    • 2
  • Yanping Liu
    • 1
  • Kei Asayama
    • 1
    • 3
    • 4
  • Tine W. Hansen
    • 5
  • Teemu J. Niiranen
    • 6
    • 7
  • José Boggia
    • 8
  • Lutgarde Thijs
    • 1
  • Jan A. Staessen
    • 1
    • 9
    Email author
  1. 1.Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular SciencesUniversity of LeuvenLeuvenBelgium
  2. 2.Internal Medicine – Hypertension SectionHospital Italiano De Buenos AiresBuenos AiresArgentina
  3. 3.Department of Planning for Drug Development and Clinical EvaluationTohoku University Graduate School of Pharmaceutical SciencesAoba-ku, SendaiJapan
  4. 4.Department of Hygiene and Public HealthTeikyo University School of MedicineItabashi-ku, TokyoJapan
  5. 5.Department of ComplicationsSteno Diabetes CenterGentofteDenmark
  6. 6.Department of Chronic Disease PreventionNational Institute for Health and WelfareTurkuFinland
  7. 7.Department of MedicineTurku University HospitalTurkuFinland
  8. 8.Centro de Nefrología and Departamento de FisiopatologíaHospital de Clínicas, Dr Manuel QuintelaMontevideoUruguay
  9. 9.Department of EpidemiologyMaastricht UniversityMaastrichtThe Netherlands

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