Predictive value of pulse pressure in acute ischemic stroke for future major vascular events

Keon Joo Lee, Beom Joon Kim, Moon Ku Han, Joon Tae Kim, Ki Hyun Cho, Dong Ick Shin, Min Ju Yeo, Jae Kwan Cha, Dae Hyun Kim, Hyun Wook Nah, Dong Eog Kim, Wi Sun Ryu, Jong Moo Park, Kyusik Kang, Soo Joo Lee, Mi Sun Oh, Kyung Ho Yu, Byung Chul Lee, Keun Sik Hong, Yong Jin ChoJay Chol Choi, Sung Il Sohn, Jeong Ho Hong, Tai Hwan Park, Sang Soon Park, Jee Hyun Kwon, Wook Joo Kim, Jun Lee, Ji Sung Lee, Juneyoung Lee, Philip B. Gorelick, Hee Joon Bae

    Research output: Contribution to journalArticlepeer-review

    13 Citations (Scopus)


    Background and Purpose—This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of ischemic stroke can be used as a predictor for future major vascular events. Methods—Using a multicenter prospective stroke registry database, patients who were hospitalized for ischemic stroke within 48 hours of onset were enrolled in this study. We analyzed blood pressure (BP) data measured during the first 3 days from onset. Primary and secondary outcomes were time to a composite of stroke recurrence, myocardial infarction, all-cause death, and time to stroke recurrence, respectively. Results—Of 9840 patients, 4.3% experienced stroke recurrence, 0.2% myocardial infarction, and 7.3% death during a 1-year follow-up period. In Cox proportional hazards models including both linear and quadratic terms of PP, PP had a nonlinear J-shaped relationship with primary (for a quadratic term of PP, P=0.004) and secondary (P<0.001) outcomes. The overall effects of PP and other BP parameters on primary and secondary outcomes were also significant (P<0.05). When predictive power of BP parameters was compared using a statistic of −2 log-likelihood differences, PP was a stronger predictor than systolic BP (8.49 versus 5.91; 6.32 versus 4.56), diastolic BP (11.42 versus 11.05; 10.07 versus 4.56), and mean atrial pressure (8.75 versus 5.91; 7.03 versus 4.56) for the primary and secondary outcomes, respectively. Conclusions—Our study shows that PP when measured in the acute period of ischemic stroke has nonlinear J-shaped relationships with major vascular events and stroke recurrence, and may have a stronger predictive power than other commonly used BP parameters.

    Original languageEnglish
    Pages (from-to)46-53
    Number of pages8
    Issue number1
    Publication statusPublished - 2018

    Bibliographical note

    Funding Information:
    This study was supported by Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI10C2020).

    Publisher Copyright:
    © 2017 American Heart Association, Inc.


    • Assessment, patient outcome
    • Blood pressure
    • Cohort studies
    • Pulse pressure
    • Stroke

    ASJC Scopus subject areas

    • Clinical Neurology
    • Cardiology and Cardiovascular Medicine
    • Advanced and Specialised Nursing


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