title: Pulse pressure as an independent predictor of stroke: a systematic review and a meta-analysis.
abstract: BACKGROUND
  Recent evidence suggests that pulse pressure (PP) is a strong cardiovascular diseases' risk factor. We systematically evaluated all relevant studies to determine whether PP can be used as an independent predictor of stroke and mortality.
  
  
  RESULTS
  A meta-analysis was performed by searching the published literature using MEDLINE, Cochrane and Google Scholar databases up to December 15, 2015. We measured the effect size expressed by hazard ratio (HR) and 95 % confidence interval (95 % CI). Eleven publications were included in the analysis. Pooled results demonstrated that 10 mmHg increase in PP was associated with increased risk of stroke occurrence (pooled HR 1.046, 95 % CI 1.025-1.068, P < 0.001). Additionally, systolic blood pressure (SBP) (pooled HR 1.053, 95 % CI 1.033-1.073, P < 0.001) and diastolic blood pressure (DPB) (pooled HR 1.056, 95 % CI 1.038-1.074, P < 0.001) were found to be significant predictors for stroke. We did not find a significant association between PP and all-cause mortality (pooled HR 1.022, 95 % CI 0.983-1.063, P = 0.270). We found SBP (pooled HR 1.008, 95 % CI 1.002-1.014, P = 0.012), but not DBP (pooled HR 1.023, 95 % CI 0.964-1.085, P = 0.451) to be significantly associated with all-cause mortality.
  
  
  CONCLUSIONS
  Current data confirms that PP is an independent risk factor for stroke but is not a predictor of mortality.
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
authors.forename: Feng-Di
authors.initials: FD
authors.lastname: Liu
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
authors.forename: Xiao-Lei
authors.initials: XL
authors.lastname: Shen
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
authors.forename: Xiao-Xiao
authors.initials: XX
authors.lastname: Tao
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
authors.forename: Shuo
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Neurology, Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China.
authors.forename: Jia-Jun
authors.initials: JJ
authors.lastname: Zhou
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zheng
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
authors.forename: Qi-Ting
authors.initials: QT
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Yao
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
authors.forename: Xue-Mei
authors.initials: XM
authors.lastname: Wang
authors.affiliation: Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China. bingming6912@163.com.
authors.forename: Hui-Qin
authors.initials: HQ
authors.lastname: Liu
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China. shuliang_9@hotmail.com.
authors.forename: Liang
authors.initials: L
authors.lastname: Shu
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China. liujr021@163.com.
authors.forename: Jian-Ren
authors.initials: JR
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
keywords: Predictor of mortality; Pulse pressure; Risk factor; Stroke