Published Online
on May 5, 2005

A more recent version of this article appeared on June 1, 2005

This Article Full Text (PDF) All Versions of this Article: 36/6/1288    most recent 01.STR.0000166201.79222.4dv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Paultre, F. Articles by Mosca, L. Search for Related Content PubMed PubMed Citation Articles by Paultre, F. Articles by Mosca, L. Related Collections Peripheral vascular disease

Submitted on January 11, 2005
Revised on February 24, 2005
Accepted on March 1, 2005

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

Furcy Paultre PhD and Lori Mosca MD, PhD^*

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

^* To whom correspondence should be addressed. 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

This article has been cited by other articles:

				L. Zheng, Z. Sun, J. Li, R. Zhang, X. Zhang, S. Liu, J. Li, C. Xu, D. Hu, and Y. Sun Pulse Pressure and Mean Arterial Pressure in Relation to Ischemic Stroke Among Patients With Uncontrolled Hypertension in Rural Areas of China Stroke, July 1, 2008; 39(7): 1932 - 1937. [Abstract] [Full Text] [PDF]

				R. H. Fagard, J. A. Staessen, L. Thijs, H. Celis, C. J. Bulpitt, P. W. de Leeuw, G. Leonetti, J. Tuomilehto, and Y. Yodfat On-Treatment Diastolic Blood Pressure and Prognosis in Systolic Hypertension Arch Intern Med, September 24, 2007; 167(17): 1884 - 1891. [Abstract] [Full Text] [PDF]

				W. J. Mosley II, P. Greenland, D. B. Garside, and D. M. Lloyd-Jones Predictive Utility of Pulse Pressure and Other Blood Pressure Measures for Cardiovascular Outcomes Hypertension, June 1, 2007; 49(6): 1256 - 1264. [Abstract] [Full Text] [PDF]

				D. L. Brown, F. Al-Senani, L. D. Lisabeth, M. A. Farnie, L. A. Colletti, K. M. Langa, A. M. Fendrick, N. M. Garcia, M. A. Smith, and L. B. Morgenstern Defining Cause of Death in Stroke Patients: The Brain Attack Surveillance in Corpus Christi Project Am. J. Epidemiol., March 1, 2007; 165(5): 591 - 596. [Abstract] [Full Text] [PDF]