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J Am Heart Assoc. 2017 Jun 22;6(6). pii: e005113. doi: 10.1161/JAHA.116.005113.

Low Pulse Pressure After Acute Ischemic Stroke is Associated With Unfavorable Outcomes: The Taiwan Stroke Registry.

Author information

1
Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
2
Department of Neurology, Cheng Hsin General Hospital, Taipei, Taiwan.
3
Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
4
Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan.
5
Department of Neurology, Tri-Service General Hospital, Taipei, Taiwan.
6
Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan.
7
Department of Neurology, China Medical University Beigang Hospital, Taichung, Taiwan.
8
Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.
9
Department of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
10
Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan.
11
Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
12
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
13
Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan jsjeng@ntu.edu.tw.
14
Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.

Abstract

BACKGROUND:

Pulse pressure (PP) is related to cardiac function, arterial stiffness, fluid status, and vascular events. This study aimed to explore the prognostic role of PP upon admission in patients with acute ischemic stroke (AIS) based on a nation-wide stroke registry.

METHODS AND RESULTS:

We evaluated the association between PP upon admission and outcomes 3 months after a stroke in patients who had an AIS registered in the Taiwan Stroke Registry, including 56 academic and community hospitals between 2006 and 2013. Three months after the stroke, unfavorable outcomes were defined using a modified Rankin scale of 3 to 6. Of 33 530 patients (female, 40.6%; mean age, 68.8±13.3 years) who had an AIS, PP upon admission had a reverse J-curve association with an unfavorable outcome. After adjusting for clinical variables, including AIS subtypes, initial National Institutes of Health Stroke Scale, and systolic and diastolic blood pressure upon admission, a PP of <50 mm Hg was associated with unfavorable outcomes (P<0.0001). Compared with patients with a PP of 50 to 69 mm Hg, the odds ratios for unfavorable outcomes were 1.24 (95% CI, 1.14-1.36) with a PP of 30 to 49 mm Hg and 1.85 (95% CI, 1.50-2.28) with a PP of <30 mm Hg. Moreover, the prognostic impact of PP upon admission was similar across all AIS subtypes.

CONCLUSIONS:

Low PP upon admission was associated with unfavorable patient outcomes in AIS.

KEYWORDS:

blood pressure; ischemic stroke; outcome; pulse pressure; stroke registry

PMID:
28642220
PMCID:
PMC5669158
DOI:
10.1161/JAHA.116.005113
[Indexed for MEDLINE]
Free PMC Article

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