Pulse pressure, arterial stiffness, and cardiovascular risk

Systolic and diastolic blood pressures are the exclusive mechanical factors usually considered as predictors of cardiovascular risk in populations of normotensive and hypertensive subjects at large. However, if hypertension is considered as a mechanical factor acting on the arterial wall with substantial deleterious consequences, the totality of the blood pressure curve should be considered in order to investigate the cardiovascular risk. The purpose of this review is to show that in addition to systolic and diastolic blood pressures, other hemodynamic indices that have particular relevance for cardiac complications and that originate from pulsatile pressure should be taken into account, with important consequences in cardiovascular epidemiology and in the pathophysiology of hypertensive end-organ damage. (C) 2000 Lippincott Williams & Wilkins, Inc.