Key result
Elevated mean pulse pressure (≥60 vs <47 mm Hg) was associated with a higher risk of recurrent hemorrhagic stroke in ischemic stroke patients (adjusted HR 6.03; 95% CI 1.04-34.99).
Why the study?
It remained uncertain which type of recurrent stroke is associated with pulse pressure in patients with ischemic stroke with cerebral microbleeds or intracerebral hemorrhage.
Does elevated pulse pressure increase the risk of recurrent hemorrhagic stroke in patients with ischemic stroke and cerebral microbleeds or intracerebral hemorrhage?
Cohort (n=1,454)
Does elevated pulse pressure increase the risk of recurrent hemorrhagic stroke in patients with ischemic stroke and cerebral microbleeds or intracerebral hemorrhage?
Long-term elevated pulse pressure confers a significantly greater risk of subsequent hemorrhagic stroke among stroke patients with cerebral microbleeds or intracerebral hemorrhage.
Answers are grounded in this paper and cite their sources.
Elevated PP was associated with hemorrhagic recurrence; leaves open whether PP-targeted BP control reduces risk in this population.
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 Ischemic 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 PP. 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. Registration URL: https://www.clinicaltrials.gov; Unique identifier, NCT01013532.
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Park et al. (2021) conducted a cohort in Ischemic stroke with cerebral microbleeds or intracerebral hemorrhage (n=1,454). Elevated mean pulse pressure (≥60 mm Hg) vs. Lowest quartile of mean pulse pressure (<47 mm Hg) was evaluated on Hemorrhagic stroke (adjusted HR 6.03, 95% CI 1.04-34.99). Elevated mean pulse pressure (≥60 vs <47 mm Hg) was associated with a higher risk of recurrent hemorrhagic stroke in ischemic stroke patients (adjusted HR 6.03; 95% CI 1.04-34.99).
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