期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 11, 期 3, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.121.022317
关键词
blood pressure; intracranial hemorrhage; risk; stroke; vascular stiffness
资金
- Korea Health Technology R&D Project through the Korea Health Industry Development Institute - Ministry of Health and Welfare, Republic of Korea [HI18C2383]
The association between pulse pressure (PP) and recurrent stroke in ischemic stroke patients with cerebral microbleeds or intracerebral hemorrhage remains uncertain. This study found that long-term elevated PP and higher systolic blood pressure confer a greater risk of subsequent hemorrhagic stroke among stroke patients with cerebral microbleeds or intracerebral hemorrhage.
BACKGROUND: Which type of recurrent stroke is associated with pulse pressure (PP) remains uncertain in ischemic stroke with cerebral microbleeds or intracerebral hemorrhage. METHODS AND RESULTS: The PICASSO (Prevention of Cardiovascular Events in lschemic Stroke Patients With High Risk of Cerebral Hemorrhage) database involving 1454 subjects was analyzed. Subjects were stratified into quartiles according to the distribution of mean PP (mm Hg) during follow-up (mean, 1.9 years): <47 (first quartile), 48 to 53 (second quartile), 54 to 59 (third quartile), and >= 60 mm Hg (fourth quartile). The primary end point was hemorrhagic stroke, and the secondary end points were ischemic stroke, stroke of any type, and major adverse cardiovascular events. Adjusted time-dependent area under the receiver operating characteristic curve analysis was performed to assess the prediction accuracy of mean PR The mean frequency of visit for blood pressure checkup was 9.4 +/- 5.5 times. The stroke incidence rate per 100 person-years was 3.14, 2.24, 5.52, and 6.22, respectively in increasing quartile of mean PP, and the rate of major adverse cardiovascular events was 3.82, 2.84, 6.37, and 7.14, respectively. In the presence of mean arterial pressure, hemorrhagic stroke risk was higher in the highest quartile (adjusted hazard ratio, 6.03; 95% CI, 1.04-34.99) versus the lowest quartile, which was evident at higher mean systolic blood pressure. Higher mean PP as a continuous variable was also a predictor of hemorrhagic stroke (1.09, 1.03-1.15). The time-dependent area under the receiver operating characteristic curve for hemorrhagic stroke was 0.79. CONCLUSIONS: Long-term elevated PP with higher systolic blood pressure confers a greater risk of subsequent hemorrhagic stroke among stroke patients with cerebral microbleeds or intracerebral hemorrhage.
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