Zheng Liqiang, Sun Zhaoqing, Li Jue, Zhang Rui, Zhang Xingang, Liu Shuangshuang, Li Jiajin, Xu Changlu, Hu Dayi, Sun Yingxian
Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, PR China.
Stroke. 2008 Jul;39(7):1932-7. doi: 10.1161/STROKEAHA.107.510677. Epub 2008 May 1.
Information has been sparse on the comparison of pulse pressure (PP) and mean arterial pressure (MAP) in relation to ischemic stroke among patients with uncontrolled hypertension. The present study examined the relation among PP, MAP, and ischemic stroke in uncontrolled hypertensive subjects in China.
A total of 6104 uncontrolled hypertensive subjects aged > or = 35 years were screened with a stratified cluster multistage sampling scheme in Fuxin county of Liaoning province of China, of which 317 had ischemic stroke.
After multivariable adjustment for age, gender, and other confounders, individuals with the highest quartile of PP and MAP had ORs for ischemic stroke of 1.479 (95% CI: 1.027 to 2.130) and 2.000 (95% CI: 1.373 to 2.914) with the lowest quartile as the reference. Adjusted ORs for ischemic stroke were 1.306 for MAP and 1.118 for PP with an increment of 1 SD, respectively. Ischemic stroke prediction of PP was annihilated when PP and MAP were entered in a single model. In patients aged < 65 years, on a continuous scale using receive operating characteristics curve, ischemic stroke was predicted by PP (P=0.001) and MAP (P<0.001). The area under the curve of PP (0.570, 95% CI: 0.531 to 0.609) differed from the area under the curve of MAP (0.633, 95% CI: 0.597 to 0.669; P<0.05). Among patients aged > or = 65 years, presence of ischemic stroke was only predicted by MAP.
PP and MAP were both associated with ischemic stroke. Ischemic stroke prediction of PP depended on MAP. On a continuous scale, MAP better predicted ischemic stroke than PP did in diagnostic accuracy.
关于血压控制不佳的患者中脉压（PP）和平均动脉压（MAP）与缺血性卒中关系的比较，相关信息一直较少。本研究在中国血压控制不佳的高血压患者中，探讨了PP、MAP与缺血性卒中之间的关系。
采用分层整群多阶段抽样方法，在中国辽宁省阜新县对6104名年龄≥35岁的血压控制不佳的高血压患者进行筛查，其中317人发生缺血性卒中。
在对年龄、性别和其他混杂因素进行多变量调整后，以最低四分位数为参照，PP和MAP处于最高四分位数的个体发生缺血性卒中的比值比（OR）分别为1.479（95%可信区间：1.027至2.130）和2.000（95%可信区间：1.373至2.914）。MAP和PP每增加1个标准差，缺血性卒中的调整后OR分别为1.306和1.118。当将PP和MAP纳入单一模型时，PP对缺血性卒中的预测作用消失。在年龄<65岁的患者中，采用受试者工作特征曲线进行连续性分析，PP（P = 0.001）和MAP（P<0.001）均可预测缺血性卒中。PP的曲线下面积（0.570，95%可信区间：0.531至0.609）与MAP的曲线下面积（0.633，95%可信区间：0.597至0.669；P<0.05）不同。在年龄≥65岁的患者中，只有MAP可预测缺血性卒中的发生。
PP和MAP均与缺血性卒中相关。PP对缺血性卒中的预测依赖于MAP。在连续性分析中，MAP对缺血性卒中的诊断准确性优于PP。
