In Ischemic Stroke, Pulse Pressure Predicts Long-Term Risk of Recurrence

blood pressure reading
blood pressure reading
Pulse pressure was associated with the risk for ischemic stroke in first-ever ischemic stroke patients old than 60 years.
The following article is part of live conference coverage from the 2017 American Academy of Neurology (AAN) annual meeting in Boston, Massachusetts. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAN 2017.

BOSTON — In a cohort of first-ever ischemic stroke patients, pulse pressure  was associated with long-term stroke risk among those 60 years or older.

Results of the multicenter, prospective, observational SMART-II trial were presented at the 2017 American Academy of Neurology Annual Meeting, April 22-28, in Boston.

Although pulse pressure has been linked to cardiovascular events and mortality in the general population, few studies have assessed baseline pulse pressure and long-term outcomes in stroke patients.

This led researchers from the Chinese Academy of Medical Science and Peking Union Medical College in Beijing, China, to enroll 4195 first-ever ischemic stroke patients (61.2 ± 11.6 years; 68.4% men) from 91 hospitals between July 2012 and February 2014. Patients had ischemic stroke within 3 months and were functionally independent before stroke (modified Rankin Scale <3).

After adjusting for age, sex, vascular risk factors, atrial fibrillation, and medication, the researchers examined the association between baseline pulse pressure and combined endpoints — recurrent vascular events and all-cause mortality — and recurrent stroke.

During follow-up (median, 23.5 months), combined endpoints occurred in 8.8% of patients and recurrent stroke occurred in 5.6% of patients.

Among patients aged <60 years, pulse pressure was not linked to long-term stroke outcomes; however, for those aged ≥60 years, pulse pressure  was significantly associated with the rates of combined endpoints (hazard ratio [HR]=1.35; 95% CI, 1.18-1.54) and recurrent stroke (HR=1.46; 95% CI, 1.24-1.72).

In addition, the combination of systolic blood pressure and pulse pressure, mean arterial pressure and pulse pressure, or diastolic blood pressure and pulse pressure showed no incremental value for systolic blood pressure, mean arterial pressure, or diastolic blood pressure in predicting long-term stroke outcomes, according to the researchers.

“Our study demonstrated the long-term prognostic implications of pulse pressure in ischemic stroke patients and the modification of this effect by age,” the researchers wrote. “In first-ever ischemic stroke patients ≥60 years of age, pulse pressure was an independent predictor for long-term stroke outcomes.”

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Su N, Zhai F, Ni J, et al. Pulse pressure in ischemic stroke is an independent predictor for long-term stroke outcomes. Presented at: 2017 American Academy of Neurology Annual Meeting. April 22-28, 2017; Boston, MA.