Systolic, Diastolic, Mean, or Pulse Pressure

Abstract

The relative importance of diastolic blood pressure (DBP), systolic blood pressure (SBP), mean arterial pressure (MAP), and pulse pressure (PP) as hypertensive cardiovascular risk factors has been controversial. The cardiovascular risks of hypertension result primarily from mechanical stresses to the left ventricle and to the vascular endothelium and media of blood vessels supplying the heart, brain, and kidneys. With the application of the sphygmomanometer to clinical medicine at the beginning of the twentieth century, DBP was thought to be initially the best measure of this risk. In the 1990s, however, authorities advocated that both SBP and DBP, whichever is higher, be used in classifying hypertensive cardiovascular risk. There are problems with the present guidelines, in that SBP and DBP represent only two inflection points on the propagated arterial pulse wave that is measured by cuff readings at the peripheral brachial artery.