Pulse pressure and mean arterial pressure in relation to ischemic stroke among patients with uncontrolled hypertension in rural areas of China

Background and Purpose - Information has been sparse on the comparison of pulse pressure (PP) and mean arterial pressure (MAP) in relation to ischemic stroke among patients with uncontrolled hypertension. The present study examined the relation among PP, MAP, and ischemic stroke in uncontrolled hypertensive subjects in China. Methods - A total of 6104 uncontrolled hypertensive subjects aged >= 35 years were screened with a stratified cluster multistage sampling scheme in Fuxin county of Liaoning province of China, of which 317 had ischemic stroke. Results - After multivariable adjustment for age, gender, and other confounders, individuals with the highest quartile of PP and MAP had ORs for ischemic stroke of 1.479 (95% CI: 1.027 to 2.130) and 2.000 (95% CI: 1.373 to 2.914) with the lowest quartile as the reference. Adjusted ORs for ischemic stroke were 1.306 for MAP and 1.118 for PP with an increment of 1 SD, respectively. Ischemic stroke prediction of PP was annihilated when PP and MAP were entered in a single model. In patients aged < 65 years, on a continuous scale using receive operating characteristics curve, ischemic stroke was predicted by PP (P = 0.001) and MAP (P < 0.001). The area under the curve of PP (0.570, 95% CI: 0.531 to 0.609) differed from the area under the curve of MAP (0.633, 95% CI: 0.597 to 0.669; P < 0.05). Among patients aged >= 65 years, presence of ischemic stroke was only predicted by MAP. Conclusion - PP and MAP were both associated with ischemic stroke. Ischemic stroke prediction of PP depended on MAP. On a continuous scale, MAP better predicted ischemic stroke than PP did in diagnostic accuracy.