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August 23/30, 2000

Blood Pressure Levels and Risk of Stroke in Elderly Patients—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(8):959-960. doi:10.1001/jama.284.8.956

In Reply: We agree that, in some conditions, hypertension may exert a protective short-term effect on stroke risk. It has already been suggested that a drastic lowering of BP in patients with carotid artery occlusive disease should be avoided.1 Because of this possibility, we paid careful attention to the treatment of hypertension and aimed for target values of systolic and diastolic pressure, respectively, in the range of 130 to 145 mm Hg and 80 to 85 mm Hg. Because of this narrow range of BP values, we are unable to investigate the J-shaped relationship between BP level and stroke risk in this sample. On the other hand, verifying the possible protective effect of hypertension using BP level as a continuous variable would have required following up hypertensive patients without treatment. This is obviously impossible for ethical reasons.