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Association between pulse pressure and ischaemic stroke in elderly patients with hypertension
Jiayi Huang1, Lin Liu1, Yu-Qing Huang1
1Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
Insights
High pulse pressure (PP) is a significant risk factor for first ischaemic stroke (IS) in elderly Chinese hypertensive patients. This finding highlights PP as an independent predictor of IS in this population.
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- The relationship between pulse pressure (PP) and the risk of first ischaemic stroke (IS) remains debated.
- Existing research shows inconsistencies regarding PP's impact on IS risk.
Purpose of the Study:
- To investigate the association between pulse pressure (PP) and the risk of first ischaemic stroke (IS).
- Focus on an elderly hypertensive population in China.
Main Methods:
- Retrospective cohort study design.
- Inclusion of hypertensive patients aged 60 years and above.
- Multivariate Cox regression analysis to assess PP and IS risk, with subgroup analyses.
Main Results:
- A total of 3315 patients were included; 206 IS cases occurred over 5.5 years.
- Each SD increment in PP correlated with a 17% increased IS risk.
- Highest PP quartile showed a 1.46-fold increased IS risk compared to the lowest.
Conclusions:
- Pulse pressure (PP) is significantly associated with ischaemic stroke (IS).
- PP is identified as an independent risk factor for IS in elderly hypertensive individuals.
Background:
The association between pulse pressure (PP) and the risk of first ischaemic stroke (IS) is inconsistent. Therefore, we evaluated the association between PP and the risk of first IS among elderly hypertensive population in China.
Methods:
This was a retrospective cohort study. Patients with hypertension and aged ≥60 years were recruited. Multivariate Cox regression was performed to evaluate the association between PP and the risk of IS. We further stratified the regression models into subgroups and test for interaction to assess whether the associations were modified by other covariates.
Results:
A total of 3315 patients with hypertension (44.49% male; mean age 71.41±7.20 years) were included, and 206 cases of IS occurred with a median follow-up of 5.5 years. The results showed that per SD mm Hg increment in PP was associated with a 17% (95% CI 1.05 to 1.40, p=0.0172) increased risk of IS. Moreover, the HR of IS for the highest quartile of PP was 1.46 (95% CI 1.18 to 1.73, p=0.0011, p for trend <0.001) comparing with the lowest quartile of PP. Subgroup analysis showed that population aged ≥70 years, male, patients with smoking or drinking habit, diabetes at baseline, being overweight, with uncontrolled blood pressure or did not take antihypertensive drugs have a higher risk for IS.
Conclusions:
We found that PP was significantly associated with IS and was an independent risk factor for IS.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.