Relation between blood pressure after an acute coronary event and subsequent cardiovascular risk.

Concepts about the relation between blood pressure and outcomes have evolved over the last 20 years from a sole emphasis on diastolic blood pressure to include both systolic blood pressure and pulse pressure. 3 Recently the Framingham heart study has provided further longitudinal data on the natural evolution of blood pressure over a person’s lifetime. The systolic pressure rises linearly between the ages of 30 and 84 years. There is initially a concurrent increase in the diastolic pressure, but between the ages of 50 and 60 years the diastolic pressure begins to decline and the pulse pressure widens steeply. It has also been shown that in young subjects the brachial systolic pressure is higher than the central aortic systolic pressure, whereas in older subjects (> 60 years) this difference disappears. The explanation for these findings is that there is an age related increase in stiffness accompanied by decreases in the elasticity and compliance of the central conduit arteries, leading to an increased arterial pulse wave velocity and an earlier return of the reflected pressure wave to the aorta.