Pulse pressure is an independent risk factor for stroke among middle-aged Japanese with normal systolic blood pressure: the JPHC study

OBJECTIVE: Although pulse pressure has been recognized a risk factor for coronary heart disease in both middle-aged and elderly, and for stroke in the elderly, the contribution of pulse pressure to the risk of stroke among the middle-aged is uncertain. METHODS: A total of 33 372 participants (11 684 men and 21 688 women aged 40-69 years) living in communities, free of prior diagnosis of cardiovascular disease and cancer, completed health check-up examination. They were followed from 1990-1992 to the end of 2004 in the Japan public health center-based prospective study on cancer and cardiovascular disease. After 422 864 person-years of follow-up, 1081 incident strokes (559 men and 522 women) were documented. RESULTS: Pulse pressure was positively associated with risk of stroke as was systolic and diastolic blood pressures. The multivariable hazard ratio of total stroke associated with a 1-SD increment (13.2 mmHg) of pulse pressure was 1.14 (1.05-1.24). The excess risk was observed for the stratum of systolic blood pressure below 140 mmHg, but not of higher systolic blood pressure levels after adjustment for diastolic blood pressure and other potential confounding factors; the multivariable hazard ratio of stroke associated with a 1-SD increment of pulse pressure was 1.32 (1.07-1.64) among persons with normal systolic blood pressure levels. CONCLUSIONS: Pulse pressure is a risk factor for stroke among normotensive individuals with systolic blood pressure below 140 mmHg, which suggests that pulse pressure may be useful to predict the risk of stroke among middle-aged nonsystolic hypertensive patients.