title: Interarm blood pressure difference and mortality in patients with acute ischemic stroke.
abstract: OBJECTIVE
  The objective of this study was to assess the prognostic value of interarm difference of blood pressure (IAD) measured in acute ischemic stroke and to investigate its association with systemic atherosclerosis.
  
  
  METHODS
  This was a hospital-based retrospective observational study. Survival data and systolic/diastolic IAD were collected in patients with acute ischemic stroke. Systemic atherosclerosis was determined based on coronary CT angiography, transesophageal echocardiography, ankle-brachial index examination, and cerebral angiography covering both intracranial and extracranial cerebral arteries.
  
  
  RESULTS
  Of 834 patients, 10.3% had a systolic IAD ≥ 10 mm Hg, and 6.0% had a diastolic IAD ≥ 10 mm Hg. During a mean follow-up period of 2.96 ± 0.95 years, 92 patients died (including 68 cardiovascular deaths). In multivariate Cox regression adjusted for cardiovascular risk factors and initial stroke severity, the presence of systolic IAD ≥ 10 mm Hg was associated with increased risk of all-cause mortality (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.16-3.35) and cardiovascular mortality (HR 2.49, 95% CI 1.39-4.46). Patients with diastolic IAD ≥ 10 mm Hg also had increased risk of all-cause mortality (HR 3.43, 95% CI 1.94-6.08) and cardiovascular mortality (HR 3.51, 95% CI 1.83-6.74). The presence of systolic or diastolic IAD ≥ 10 mm Hg was associated with peripheral artery disease in the lower limbs, but not with atherosclerosis in the cerebral artery, coronary artery, or the aorta.
  
  
  CONCLUSIONS
  The presence of interarm systolic or diastolic blood pressure difference ≥ 10 mm Hg is a strong independent prognostic marker in acute ischemic stroke.
authors.affiliation: Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea.
authors.forename: Jinkwon
authors.initials: J
authors.lastname: Kim
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Song
authors.forename: Dongbeom
authors.initials: D
authors.lastname: Song
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.forename: Chung Mo
authors.initials: CM
authors.lastname: Nam
authors.forename: Hyo Suk
authors.initials: HS
authors.lastname: Nam
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Kim
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply; D050197:Atherosclerosis / Q000150:complications / Q000503:physiopathology; D015415:Biomarkers; D001794:Blood Pressure / Q000502:physiology*; D002545:Brain Ischemia / Q000401:mortality* / Q000503:physiopathology*; D002423:Cause of Death; D002560:Cerebrovascular Circulation / Q000502:physiology; D003326:Coronary Circulation; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality* / Q000503:physiopathology*; D016019:Survival Analysis
chemical_list: D015415:Biomarkers