To the Editor.
— Treatment of all persons with isolated systemic hypertension in the Veterans Affairs medical system is not practical. I hope that the recent report1 on stroke prevention by antihypertensive drug therapy in older persons with isolated systemic hypertension contains hidden information that may help practitioners establish selection criteria for treating isolated systemic hypertension.Because of the relatively low incidence of strokes in persons with isolated systemic hypertension (one to two per year per 100 persons),1 the public health impact of treating isolated systemic hypertension is expected to be modest. The incidence of total strokes was reduced by 36%, with a 5-year absolute benefit of 30 events per 1000 participants. Stroke reduction was more pronounced (48%) in patients who were receiving antihypertensive therapy at initial contact than in previously untreated patients (27%). The wash-out period in previously treated patients was 2 to 8 weeks. This interval
Simon G. Prevention of Stroke in Older Persons With Isolated Systolic Hypertension. JAMA. 1991;266(20):2829. doi:10.1001/jama.1991.03470200041012