Interaction between Antihypertensive Therapy Class and Pulse Pressure on Outcomes Following Acute Ischemic Stroke

Authors: Michael Lavelle, Roy O. Mathew, Jaspreet Arora, Avinash Murthy, Le Du, Batyrjan Bulibek, Mandeep Sidhu, Mikhail Torosoff

Goal: The effect of pulse pressure and interactions with type of antihypertensive therapy on mortality after acute ischemic stroke has not been previously evaluated. Materials and Methods: A retrospective cohort study was conducted to evaluate the independent and interactive effects of pulse pressure and antihypertensive class (specifically angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker, or beta blocker) on mortality following acute ischemic stroke. Findings/Conclusions: 343 patients were identified with 49 months of follow-up. Baseline pulse pressure was 64 mmHg and age was 66.5 years. Patients were divided at a pulse pressure of 70. Patients with pulse pressure ≥ 70 were older (p < 0.001) and had higher comorbid vascular burden (p = 0.031) than those with pulse pressure < 70. Pulse pressure did not remain a significant predictor of follow-up mortality after adjustment for baseline comorbidities. Angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker based therapy was associated with lower follow-up mortality when beta blocker was not used in pulse pressure < 70 group (odds ratio 0.07, 95% confidence interval 0.01 – 0.48). Prospective analysis will be needed to confirm the protective effect of angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker based on pulse pressure in acute ischemic stroke.


Journal: International Journal of Clinical Medicine
DOI: 10.4236/ijcm.2017.810051 (PDF)
Paper Id: 79652 (metadata)

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