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(Stroke. 2005;36:1288.)
© 2005 American Heart Association, Inc.

Research Reports

Association of Blood Pressure Indices and Stroke Mortality in Isolated Systolic Hypertension

From the Columbia University, College of Physicians and Surgeons, New York, NY.

Correspondence to Dr Lori Mosca, Columbia University, College of Physicians and Surgeons, PH 10-203, 622 W 168th St, New York, NY 10032. E-mail ljm10{at}columbia.edu

Background and Purpose— Isolated systolic hypertension (ISH), systolic blood pressure (BP) 160 mm Hg and diastolic BP (DBP) <90 mm Hg, is associated with stroke; however, the correlation between specific BP indices and stroke mortality in ISH is not defined.

Methods— In a pooled analysis of 9 epidemiological studies, we examined whether pulse pressure (PP) was more predictive of stroke mortality than systolic BP (SBP), DBP, or mean BP (MAP) in persons with ISH. Subjects (n=682; 29% male; 77% white; mean age 63.6 years) with ISH, free of cardiovascular disease, and not on antihypertensive drug therapy at baseline were followed a mean of 13.0±7.3 years, and 54 stroke deaths occurred. The relative importance of each BP index was compared by the decrease in the –2 log likelihood (a measure of model agreement with data) because of the addition of 1 or a combination of BP indices to a Cox regression model. Hazards ratios (HRs) for fatal stroke for a 1-SD in BP index were determined.

Results— PP was the best predictor of stroke mortality based on the decrease in the –2 log likelihood (10.65; P=0.001; HR=1.52), followed by SBP (7.19; P=0.007; HR=1.40), DBP (2.76; P=0.10; HR=0.80), or MAP (0.39; P=0.39; HR=1.10). Any combination of BP indices did not exceed a decrease in the –2 log likelihood of 10.72.

Conclusion— These data suggest that in persons with ISH, PP is a better predictor of fatal stroke than SBP, DBP, or MAP.

Key Words: blood pressure • hypertension • stroke

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