Why the study?
Does the level of blood pressure achieved with antihypertensive treatment affect the risk of first-ever stroke in elderly patients?
Does the level of blood pressure achieved with antihypertensive treatment affect the risk of first-ever stroke in elderly patients?
In elderly treated hypertensive patients, a J-shaped relationship exists between blood pressure and stroke risk, suggesting that excessively lowering blood pressure may increase stroke risk.
May warrant caution against excessive BP lowering in treated elderly; challenges lower-is-better consensus and leaves optimal targets open.
The objective of this study was to investigate the relationship between hypertension and risk of stroke in the elderly. The study was performed within the framework of the Rotterdam Study, a prospective population-based cohort study. The risk of first-ever stroke was associated with hypertension (relative risk, 1.6; 95% CI, 1.2 to 2.0) and with isolated systolic hypertension (relative risk, 1.7; 95% CI, 1.1 to 2.6). We found a continuous increase in stroke incidence with increasing blood pressure in nontreated subjects. In treated subjects, we found a J-shaped relation between blood pressure and the risk of stroke. In the lowest category of diastolic blood pressure, the increase of stroke risk was statistically significant compared with the reference category. Hypertension and isolated systolic hypertension are strong risk factors for stroke in the elderly. The increased stroke risk in the lowest stratum of blood pressure in treated hypertensive patients may indicate that the therapeutic goal of "the lower the better" is not the optimal strategy in the elderly.
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Vokó et al. (1999) studied this question.
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