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(Stroke. 2006;37:358.)
© 2006 American Heart Association, Inc.

Original Contributions

The Significance of Various Blood Pressure Indices for Long-Term Stroke, Coronary Heart Disease, and All-Cause Mortality in Men

The Israeli Ischemic Heart Disease Study

From the H.N. Neufeld Cardiac Research Institute (D.W., U.G.), Sheba Medical Center, Tel Hashomer, Israel; Department of Epidemiology and Preventive Medicine (U.G.), Tel Aviv University, Israel.

Correspondence to Uri Goldbourt, PhD, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer 52621, Israel. E-mail goldbu1{at}post.tau.ac.il

Background and Purpose— Studies of blood pressure (BP) indices as disease predictors have offered conflicting conclusions. We compare pulse pressure (PP), systolic BP (SBP) and diastolic BP (DBP), and mean arterial pressure (MAP) as risk markers for long-term mortality with emphasis on stroke.

Methods— Male civil servants (40 to 65 years of age; n=9611) were examined in 1963 and followed up until 1986. Multivariate analysis was used to assess the association between BP indices and subsequent mortality. Stroke mortality was analyzed separately for initially normotensive (SBP140 and DBP90 mm Hg), hypertensive (SBP>140 and DBP>90 mm Hg), and men with isolated systolic hypertension (ISH; SBP>140 and DBP90 mm Hg).

Results— During follow-up, 3167 men died, including 932 of coronary heart disease and 339 of stroke. All 4 BP indices were predictive of fatal stroke among hypertensive and normotensive men (hazard ratios [HRs] fluctuated between 1.59 and 2.51). In models with 2 BP indices among normotensive men, SBP but not DBP remained a predictor of stroke mortality. MAP and PP were independent predictors of stroke mortality. Among hypertensive men, SBP and DBP were independent predictors of stroke mortality (HRs, 1.68 and 1.51, respectively). MAP but not PP remained a predictor of stroke mortality. In men with ISH, the 4 BP indices predicted fatal stroke, with HRs fluctuating between 1.24 and 2.04.

Conclusions— All 4 BP indices were predictors of stroke mortality among hypertensive and normotensive men, with DBP possibly the weaker predictor among the latter. Models with 2 BP indices yielded complex associations.

Key Words: blood pressure • coronary heart disease • mortality • prospective studies • stroke

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