The sixth Joint National Committee (JNC-VI) classification system of blood pressure emphasizes both systolic blood pressure (SBP) and diastolic blood pressure (DBP) for cardiovascular disease risk assessment. Pulse pressure (PP) = [SBP-DBP], may also be a valuable risk assessment tool.

In this study, we examined the association of cardiovascular events with arterial pulse pressure in elderly as well as their correlations within diabetes.

A Population based survey supported by WHO and FNUAP, was undertaken in 2008-2009 to investigate health behaviours and health status of elderly living in their home in Monastir. This study was carried out in a representative sample of elderly aged more than 65 years. Standardized techniques were used for blood pressure (BP). Hypertension was defined as BP more than 140/90mmHg. Diabetes was defined as known diabetics. Regression analyses were used to examine the relationships among pulse pressure age, diabetes and cardiovascular events (myocardial infarction, arteritis and stroke).This project was approved by the research Ethics Committee, CHU F Bourguiba, university of Monastir

The study included 598 participants (396 women and 202 men) who were aged ≥65 years. The prevalence of hypertension and diabetes was respectively 52% (n=311) and 27,4% (n= 164). Pulse pressure was more than 65mmHg for 132 subjects (22%), only 43 subjects without a history of hypertension. The mean of PP is significantly high in hypertensive elderly (52.3 vs 58.4mmHg), with cardiovascular events (55 vs 58mmHg), diabetic subjects (53 vs 58mmHg), with comorbidity (54 vs 58mmHg) and polymedication (52 vs 57mmHg). Using pulse pressure (high PP ≥65mmHg) as dependent variable, the multiple regression analysis reveals the independent influence of diabetes and cardiovascular events on PP.

This study has confirmed that subjects with the widest PP have the greatest risk of cardiovascular events. Elderly diabetic patients have a higher PP than non diabetic elderly. These hemodynamic changes may contribute to the increase risk of cardiovascular disease associated with diabetes.