Park JH, Lee J, Kwon SU, et al. - Among stroke patients with cerebral microbleeds or intracerebral hemorrhage, a greater risk of subsequent hemorrhagic stroke was observed in relation to long‐term elevated pulse pressure (PP) with higher systolic blood pressure.

• This is an analysis of PICASSO (Prevention of Cardiovascular Events in Ischemic Stroke Patients With High Risk of Cerebral Hemorrhage) database comprising 1,454 individuals; they were split into quartiles based on distribution of mean PP (mm Hg) during follow‐up (mean, 1.9 years): <47 (first quartile), 48 to 53 (second quartile), 54 to 59 (third quartile), and ≥60 mm Hg (fourth quartile).

• Per 100 person‐years, the rate of stroke incidence was estimated to be 3.14, 2.24, 5.52, and 6.22, respectively in increasing quartile of mean PP, and major adverse cardiovascular events rate was 3.82, 2.84, 6.37, and 7.14, respectively.

• In the presence of mean arterial pressure, a higher risk of hemorrhagic stroke was observed in the highest quartile (adjusted hazard ratio, 6.03) vs the lowest quartile, which was evident at higher mean systolic blood pressure.

• Hemorrhagic stroke was predicted by higher mean PP as a continuous variable (1.09).

• For hemorrhagic stroke, time‐dependent area under the receiver operating characteristic curve was 0.79.