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Blood Pressure, Carotid Flow Pulsatility, and the Risk of Stroke: A Community-Based Study
Shao-Yuan Chuang1, Hao-Min Cheng1, Chyi-Huey Bai1
1From Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan, R.O.C. (S.-Y.C., W.-H.P.); Department of Medical Education, Taipei Veterans General Hospital, and Department of Medicine and Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan R.O.C. (H.-M.C.); Central Laboratory, Shin Kong WHS Memorial Hospital, and the School of Public Health, Taipei Medical University, Taiwan, R.O.C. (C.-H.B.); Division of Epidemiology and Genetics, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, R.O.C. (W.-T.Y., W.-H.P.); and Department of Neurology, Yuanlin Christian Hospital, Siluo, Yuanlin, Taiwan, R.O.C. (J.-R.C.).
Insights
High central systolic blood pressure (CSBP) and high pulsatility index (PI) significantly increase stroke risk. Combining high CSBP and high PI results in a 13-fold higher risk of stroke.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Medical Imaging
Background:
- High blood pressure is a primary driver of cardiovascular events.
- Carotid flow pulsatility is also linked to cardiovascular events, but its combined effect with blood pressure on stroke risk is not fully understood.
Purpose of the Study:
- To investigate the combined influence of central blood pressure and pulsatility index (PI) on stroke incidence.
Main Methods:
- A cohort of 2033 adults without prior stroke was followed for incident stroke.
- Common carotid flow pulsatility index (PI) was measured.
- Hazard ratios for stroke were calculated using Cox proportional hazard models for central systolic blood pressure (CSBP) and PI.
Main Results:
- Higher tertiles of CSBP and PI were associated with increased stroke incidence.
- Individuals with high CSBP and high PI had a 13-fold increased stroke risk compared to those with low CSBP and low PI, after adjusting for traditional risk factors.
Conclusions:
- Central systolic blood pressure (CSBP) and common carotid PI independently predict stroke.
- Carotid flow pulsatility appears to be a significant factor in stroke development.
Background And Purpose:
High blood pressure is a major cause of cardiovascular events, and carotid flow pulsatility may be associated with cardiovascular events. However, the combined effect of blood pressure and flow pulsatility on the development of stroke remains unclear. Therefore, we investigated the combined influence of central blood pressure and pulsatility index (PI) on the incidence of stroke.
Methods:
Baseline data from 2033 adults (≥30 years) without stroke history in the Cardiovascular Disease Risk Factor Two-Township Study were linked to incident stroke. Common carotid flow PI was calculated by peak systolic velocity, end-diastolic velocity, and mean vessel velocity, which were measured in the common carotid artery. Hazard ratios for the risk of total stroke resulting from high central systolic blood pressure (CSBP) and high PI were calculated with Cox proportional hazard models.
Results:
Over a median follow-up of 9.81 years, 132 people incurred stroke events. The incidence rates of stroke were 1.3, 6.4, and 13.2 per 1000 person-years for tertile groups of CSBP (P for trend<0.05) and 4.3, 7.0, and 9.4 per 1000 person-years for tertile groups of PI (P for trend<0.05). Compared with the first tertile of CSBP, hazard ratios were 4.88 (95% confidence interval, 2.29-10.43) for the second tertile and 10.42 (5.05-21.53) for the third tertile. Hazard ratios of PI were 2.18 (1.39-3.42; third tertile) and 1.64 (1.02-2.63; second tertile) compared with the first tertile. The individuals with a high CSBP and high PI had a 13-fold higher stroke risk compared with those with low CSBP and low PI (13.2; 1.75-99.71) after adjusting for age, sex, and traditional cardiovascular risk.
Conclusions:
CSBP and common carotid PI jointly and independently predicted future stroke. Carotid flow pulsatility may play an important role in the development of stroke.
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