Abstract WP130: Association of Large Inter-arm Blood Pressure Difference With Mortality And Systemic Atherosclerosis In Acute Stroke Patients
Backgrounds: Large inter-arm difference of blood pressure (IAD) is associated with development of cardiovascular events and increased mortality in the general population and in patients with cardiovascular risk factors. However, it is unknown whether the presence of large IAD has prognostic value in acute stroke patients and whether it is associated with atherosclerosis on other vascular beds (cerebral, coronary, and peripheral arteries, and aorta). We evaluated the prognostic value of large IAD measured in acute ischemic stroke, and the association between large IAD and atherosclerosis on multiple arterial beds (cerebral, coronary, and peripheral arteries, and aorta).
Methods: We included 836 consecutive patients with acute ischemic stroke. Large IAD was defined by more than 10 mmHg absolute difference of systolic blood pressure between the arms. The presence of systemic atherosclerosis was determined based on cerebral angiography, coronary CT angiography, transesophageal echocardiograpghy and ankle-brachial index examination.
Results: Large IAD was observed in 7.4 % of patients. During a mean study period of 419.4 ± 250.2 days, 48 patients (5.7 %) died (including 34 cardiovascular deaths). The Kaplan-Meier survival curves showed significantly higher mortality in the group with large IAD than those without (Figure, a log-rank test, (A) p<0.001 in all-cause death, (B) p<0.001 in cardiovascular death). In multivariate Cox regression, large IAD was associated with increased all-cause mortality (adjusted HR is 3.040, p=0.002), and cardiovascular mortality (adjusted HR is 3.612, p=0.002). The presence of large IAD was associated with peripheral artery disease in the lower limbs (p=0.005), but not with atherosclerosis in the cerebral artery, coronary artery or the aorta.
Conclusions: The presence of large IAD is a strong independent prognostic marker in acute ischemic stroke.
- © 2012 by American Heart Association, Inc.