This Article Full Text Full Text (PDF) CME: Take the course for this article: Hypertension: October 2007, Volume 50, Number 4 All Versions of this Article: 50/4/630    most recent HYPERTENSIONAHA.107.095513v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Benjo, A. Articles by Nyhan, D. Search for Related Content PubMed PubMed Citation Articles by Benjo, A. Articles by Nyhan, D. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Clinical Studies Cerebrovascular disease/stroke Other Vascular biology CV surgery: other Acute Stroke Syndromes

(Hypertension. 2007;50:630.)
© 2007 American Heart Association, Inc.

Original Articles

Pulse Pressure Is an Age-Independent Predictor of Stroke Development After Cardiac Surgery

Alexandre Benjo; Richard E. Thompson; Derek Fine; Charles W. Hogue; Diane Alejo; Anita Kaw; Gary Gerstenblith; Ashish Shah; Dan E. Berkowitz; Daniel Nyhan

From the Departments of Anesthesiology and Critical Care Medicine (A.B., D.F., C.W.H., D.A., A.K., D.E.B., D.N.), Biostatistics (R.E.T.), Cardiology (G.G.), and Cardiac Surgery (A.S.), Johns Hopkins Medical Institutions and Bloomberg School of Public Health (R.E.T.), Baltimore, Md.

Correspondence to Daniel Nyhan, Anesthesiology, Tower 711, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287. E-mail dnyhan{at}jhmi.edu

Chronologic age is a strong predictor of adverse outcomes after cardiac surgery. The variability in age-related cardiovascular changes suggests that age may not be the most accurate predictor of adverse perioperative outcomes. Vascular stiffness has emerged as an important surrogate of vascular aging. In a retrospective review, we investigated the value of vascular stiffness, as assessed by brachial pulse pressure (PP) measurements, in predicting stroke in 703 patients (63.4% men and 36.6% women). Patients were followed for 348±215 days after cardiac surgery. We used a multivariable logistic model and unadjusted and adjusted Cox proportional-hazard models to assess the probability of stroke and the hazards of stroke over time. Stroke patients had a significantly higher PP (81.2 mm Hg versus 64.5 mm Hg; P=0.0006). In the logistic regression model, PP was an independent predictor of stroke development (unadjusted odds ratio: 1.35; 95% CI: 1.13 to 1.62, for every 10-mm Hg increase in PP; P=0.001). In the unadjusted and adjusted Cox models, PP again predicted stroke (hazard ratio: 1.32; 95% CI: 1.12 to 1.57; hazard ratio: 2.62; 95% CI: 1.49 to 4.60, respectively; P=0.001 for both) for every 10 mm Hg increase in PP. Age, gender, and diabetes were not independent predictors of stroke. Ejection fraction was inversely related to stroke in the adjusted model. Kaplan–Meier estimates and corresponding log-rank test indicated that the probability of stroke-free survival function was significantly lower (P=0.0067) in patients with PP >72 mm Hg versus <72 mm Hg. This analysis suggests that indices of vascular stiffness could be important predictors of neurologic complications.

Key Words: clinical science • cardiac surgery • pulse pressures • stroke • hypertension