Mean Arterial Pressure: A Better Marker of Stroke in Patients with Uncontrolled Hypertension in Rural Areas of China

OBJECTIVE: The purpose of this study was to compare the association of pulse pressure (PP) and mean arterial pressure (MAP) with stroke in uncontrolled hypertensive subjects. METHODS: A total of 9,901 uncontrolled hypertensive subjects were included in a cross-sectional study in 62 villages of Fuxin county of Liaoning Province, China. RESULTS: Among the 9,901, 406 cases of ischemic stroke and 145 cases of cerebral hemorrhage were identified. Older age, male gender, increased SBP, higher DBP, and history of hyperlipemia were positively associated with both ischemic stroke and cerebral hemorrhage by multivariate logistic regression analysis. However, the odds rations (ORs) of drinking for ischemic stroke and cerebral hemorrhage were 0.407 (95%CI: 0.304-0.544) and 0.595 (95%CI: 0.377-0.940), respectively. An increase of 10 mmHg of MAP had ORs of 1.430 (95%CI: 1.332-1.535) for ischemic stroke and 1.359 (95%CI: 1.220-1.514) for cerebral hemorrhage. The OR of PP (per 10 mmHg increase) for ischemic stroke was 1.085 (95%CI: 1.026-1.148). Subjects with the fourth quartile of PP and MAP had ORs of 1.555 (95%CI: 1.127-2.146) ischemic stroke and 5.127 (95%CI: 3.452-7.616) for cerebral hemorrhage, with the first quartile as the reference group. The OR of the fourth quartile of MAP for cerebral hemorrhage was 5.935 (95%CI: 2.932-12.012). There was no significant association between PP and cerebral hemorrhage. In sensitivity analysis, ORs of standard MAP for ischemic stroke were higher than those of PP in each stratified age subgroup. CONCLUSIONS: Increased MAP and PP were significant markers of ischemic stroke and cerebral hemorrhage was only associated with increased MAP. MAP was more closely associated with stroke than PP in patients with uncontrolled hypertension.