Author(s)

Michael Lavelle¹, Roy O. Mathew², Jaspreet Arora³, Avinash Murthy³, Le Du³, Batyrjan Bulibek³, Mandeep Sidhu⁴, Mikhail Torosoff^4*

¹Department of Internal Medicine, Columbia University, New York Presbyterian Hospital, New York, NY, USA.
²Department of Medicine, William Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA.
³Department of Internal Medicine, Albany Medical College, Albany, NY, USA.
⁴Division of Cardiology, Albany Medical Center, Albany, NY, USA.

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.

Acute Ischemic Stroke, Pulse Pressure, Angiotensin Blockers, Beta Blockers, Outcomes

Lavelle, M. , Mathew, R. , Arora, J. , Murthy, A. , Du, L. , Bulibek, B. , Sidhu, M. and Torosoff, M. (2017) Interaction between Antihypertensive Therapy Class and Pulse Pressure on Outcomes Following Acute Ischemic Stroke. International Journal of Clinical Medicine, 8, 543-555. doi: 10.4236/ijcm.2017.810051.