Association of blood pressure indices and stroke mortality in isolated systolic hypertension.
OBJECTIVE
Isolated systolic hypertension (ISH), systolic blood pressure (BP) > or =160 mm Hg and diastolic BP (DBP) <90 mm Hg, is associated with stroke; however, the correlation between specific BP indices and stroke mortality in ISH is not defined.


METHODS
In a pooled analysis of 9 epidemiological studies, we examined whether pulse pressure (PP) was more predictive of stroke mortality than systolic BP (SBP), DBP, or mean BP (MAP) in persons with ISH. Subjects (n=682; 29% male; 77% white; mean age 63.6 years) with ISH, free of cardiovascular disease, and not on antihypertensive drug therapy at baseline were followed a mean of 13.0+/-7.3 years, and 54 stroke deaths occurred. The relative importance of each BP index was compared by the decrease in the -2 log likelihood (a measure of model agreement with data) because of the addition of 1 or a combination of BP indices to a Cox regression model. Hazards ratios (HRs) for fatal stroke for a 1-SD in BP index were determined.


RESULTS
PP was the best predictor of stroke mortality based on the decrease in the -2 log likelihood (10.65; P=0.001; HR=1.52), followed by SBP (7.19; P=0.007; HR=1.40), DBP (2.76; P=0.10; HR=0.80), or MAP (0.39; P=0.39; HR=1.10). Any combination of BP indices did not exceed a decrease in the -2 log likelihood of 10.72.


CONCLUSIONS
These data suggest that in persons with ISH, PP is a better predictor of fatal stroke than SBP, DBP, or MAP.
Paultre
Furcy
F
Columbia University, College of Physicians and Surgeons, PH 10-203, 622 W 168th St, New York, NY 10032, USA.
Mosca
Lori
L
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D015331:Cohort Studies; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D020521:Stroke / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D013599:Systole
D000959:Antihypertensive Agents