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

Abstract

BackgroundPulse 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 ResultsWe 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.ConclusionsLow PP upon admission was associated with unfavorable patient outcomes in AIS.

One-Year Risk of Recurrent Stroke and Death Associated with Vertebrobasilar Artery Stenosis and Occlusion in a Cohort of 10,515 Patients

“…In some patients, lack of follow-up was thought to be due to excellent recovery, and follow-up was not considered necessary or nursing home disposition due to severe disability and therefore unable to return for follow-up. The biases due to proportion of data missing nonrandomly are possible [6]. The patients were classified into strata based on severity of stenosis at local sites.…”

“…We analyzed data from the TSR, which was launched in 2006 and sponsored by the Taiwan Ministry of Health and Welfare with the approval from Institutional Review Boards of 59 academic and community hospitals in Taiwan [6]. Details of the program have been reported elsewhere [6].…”

“…Details of the program have been reported elsewhere [6]. Briefly, all subjects with ischemic stroke or TIA were included if the patient: (1) presented within 10 days of symptom onset to a hospital participating in registry and (2) received examination including computed tomography and/or magnetic resonance imaging for this index event.…”

Association of cyclophilin A level and pulse pressure in predicting recurrence of cerebral infarction

“…Accumulating evidence has indicated that PP was superior to other BP parameters, including SBP, DBP, and MAP, in predicting the prognosis of serious cardiovascular and cerebrovascular morbidity and mortality. A recent study from the Taiwan stroke registry showed a U‐shape relationship between PP at admission and 3‐month functional outcome after ischemic stroke . Lots of studies of antihypertensive drug therapy on changes in PP vs changes in CIMT indicate slight or inconsistent reductions of wall thickness which are substantially less than that obtained with lipid‐lowering agents .…”

Registry-based stroke research in Taiwan: past and future

“…Several research articles from the TSR have been published in prestigious journals, mainly focusing on the predictors of patient-centered outcomes [ 17 - 20 ]. For example, Tang et al [ 18 ] found that low pulse pressure upon admission was associated with poorer 3-month outcomes in patients with acute ischemic stroke. The findings from these studies may provide useful information for the prognostication and management of stroke patients.…”