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From the Veterans Affairs Boston Healthcare System - Massachusetts Veterans Affairs Epidemiology, Research and Information Center (T.S.B., H.D.S., J.M.G.); Department of Neurology, Boston University School of Medicine (C.S.K.); Divisions of Aging (T.S.B., T.K., J.M.G.) and Preventive Medicine (T.K., H.D.S., J.M.G.), Department of Medicine, Brigham and Women's Hospital; and the Department of Epidemiology (T.K., H.D.S.), Harvard School of Public Health, Boston, MA.
Address correspondence and reprint requests to Dr. Thomas S. Bowman, Massachusetts Veterans Affairs Epidemiology, Research and Information Center, MAV-151, 150 South Huntington Avenue, Boston, MA 02130; e-mail: tsbowman{at}partners.org
Objective: To evaluate which blood pressure measure is the best predictor of risk of total, ischemic, and hemorrhagic stroke.
Methods: The authors used a prospective cohort study among 11,466 men followed for incident stroke during a median of 19.4 years in the Physicians' Health Study. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were self-reported. They calculated relative risks (RRs) and 95% CIs for total, ischemic, and hemorrhagic stroke using Cox proportional hazards models. Model fit was compared using the 
2 test statistic from likelihood ratio tests.
Results: During follow-up, 508 strokes occurred (411 ischemic, 89 hemorrhagic, and eight of unknown etiology). For each 10-mm Hg increase in SBP, the multivariable RRs were 1.31 (95% CI: 1.20 to 1.42) for total stroke, 1.28 (95% CI: 1.16 to 1.40) for ischemic stroke, and 1.38 (95% CI: 1.13 to 1.68) for hemorrhagic stroke. Although DBP, pulse pressure, and mean arterial pressure were all significant predictors of stroke risk, none was a significantly better predictor than SBP alone. Adding DBP did not significantly improve the model fit of SBP alone for any stroke type.
Conclusion: In this large cohort of initially healthy men, systolic blood pressure was a consistent and significant predictor of total, ischemic, and hemorrhagic stroke. Systolic blood pressure alone was the only measure necessary to predict risk of total stroke or its major subtypes.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the September 12 issue to find the title link for this article.
Dr. Bowman is supported by a Career Development Award from the Cooperative Studies Program of the U.S. Department of Veterans Affairs. This work was supported by grants CA-34944 and CA 40360 from the National Cancer Institute, and grants HL 26490 and HL 34595 from the National Heart, Lung, and Blood Institute, Bethesda, MD.
Disclosure: The authors report no conflicts of interest.
An oral abstract of this work was presented on February 18, 2006, as part of the Robert G. Siekert award presentation to Dr. Bowman at the 2006 International Stroke Conference in Kissimmee, FL.
Received November 21, 2005. Accepted in final form May 9, 2006.
Related Article
Neurology 2006 67: 734-735.
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