High Pulse Pressure is a Risk Factor for Stroke in Elderly Individuals with Coronary Heart Disease and Diabetes Mellitus

Background: The association between pulse pressure and the risk of stroke in elderly patients with multiple comorbidities is not well understood. The present study aimed to investigate the association between pulse pressure and the risk of stroke in elderly patients.Measurements: We retrospectively assessed stroke/ transient ischemic attack (TIA) risk factors in 623 patients (33% female, median age, 74 years) with coronary heart disease (CHD) and diabetes mellitus (DM) at Chinese PLA General Hospital. The effects of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure on the risk of stroke/TIA were assessed using a binary logistic regression analysis. The ability of changes in blood pressure to predict the risk of stroke/TIA was assessed using a receiver operating characteristics curve.Results: 228 (36.59%) patients had a stroke/TIA. DBP was significantly lower in the patients with stroke/TIA than in those without (75.83 ± 11.14 vs. 78.91 ± 11.85, P = 0.001). Pulse pressure was markedly higher in the stroke/TIA compared with the non-stroke/TIA group (61.34 ± 14.59 vs. 56.01 ± 14.65, P < 0.001). SBP was not significantly different between the groups. The multivariate analysis revealed pulse pressure (odds ratio, (OR), 1.02, 95% confidential interval (CI), 1.01–1.04, P < 0.001) and DBP ≤70 mmHg (OR, 95% CI, 1.44, 1.01–2.06, P=0.044) were independently associated with the risk of stroke/TIA. The c-statistics (95% CI) for pulse pressure and DBP ≤70 mmHg for predicting stroke/TIA were 0.62 (0.57–0.66; P<0.001) and 0.56 (0.51-0.61; P=0.006), respectively. A cutoff of 38 mmHg pulse pressure showed good predictive ability for the risk of stroke/TIA (sensitivity 97%, specificity 96%).Conclusion: Low DBP and high pulse pressure, most likely the result of the low DBP, were risk factors for stroke/TIA in elderly patients with CHD and DM