(Hypertension. 1999;34:1181.)
© 1999 American Heart Association, Inc.
Scientific Contributions |
J-Shaped Relation Between Blood Pressure and Stroke in Treated Hypertensives
From the Department of Epidemiology and Biostatistics, Erasmus University Medical School (Z.V., M.L.B., A.H., J.C.M.W., M.M.B.B.), Rotterdam; University Medical Center Utrecht (M.L.B.); and Department of Neurology, University Hospital Rotterdam (P.J.K.), Netherlands.
Correspondence to Monique M.B. Breteler, MD, PhD, Department of Epidemiology and Biostatistics, Erasmus University Medical School, 3000DR Rotterdam, PO Box 1738, Netherlands. E-mail breteler{at}epib.fgg.eur.nl
Abstract—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.
Key Words: cerebrovascular disorders • stroke • blood pressure • cohort studies • drug therapy
This article has been cited by other articles:
 |
|
 |
|
  E. Pinto Blood pressure and ageing Postgrad. Med. J., February 1, 2007; 83(976): 109 - 114. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. K. Ikram, F. J. de Jong, M. J. Bos, J. R. Vingerling, A. Hofman, P. J. Koudstaal, P. T.V.M. de Jong, and M.M.B. Breteler Retinal vessel diameters and risk of stroke: The Rotterdam Study Neurology, May 9, 2006; 66(9): 1339 - 1343. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H. Samson Hypertension and the Vascular Patient Vascular and Endovascular Surgery, March 1, 2004; 38(2): 103 - 119. [Abstract] [PDF]
|
|
|
|
 |
|
 K. C. Mange, H. I. Feldman, M. M. Joffe, K. Fa, and R. D. Bloom Blood Pressure and the Survival of Renal Allografts from Living Donors J. Am. Soc. Nephrol., January 1, 2004; 15(1): 187 - 193. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C-K Wong and H D White Relation between blood pressure after an acute coronary event and subsequent cardiovascular risk Heart, December 1, 2002; 88(6): 555 - 558. [Full Text] [PDF]
|
|
|
|
|
|
J Amar, B Chamontin, J Ferrieres, N Danchin, O Grenier, C Cantet, and J-P Cambou Hypertension control at hospital discharge after acute coronary event: influence on cardiovascular prognosis--the PREVENIR study Heart, December 1, 2002; 88(6): 587 - 591. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Friday, M. Alter, and S.-M. Lai Control of Hypertension and Risk of Stroke Recurrence Stroke, November 1, 2002; 33(11): 2652 - 2657. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. D. Murthy Barriers to Blood Pressure Control Arch Intern Med, October 28, 2002; 162(19): 2245 - 2245. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Tilling, J. A. C. Sterne, and M. Szklo Estimating the Effect of Cardiovascular Risk Factors on All-Cause Mortality and Incidence of Coronary Heart Disease Using G-Estimation: The Atherosclerosis Risk in Communities Study Am. J. Epidemiol., April 15, 2002; 155(8): 710 - 718. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Ribstein, G. Du Cailar, and A. Zanchetti Cardiac and renal damage in the elderly hypertensive Journal of Renin-Angiotensin-Aldosterone System, March 1, 2002; 3(1_suppl): S16 - S24. [PDF]
|
|
|
|
 |
|
 D. W. Baker, V. A. Portnoi, D. J. Hyman, V. N. Pavlik, and A. V. Chobanian Control of Hypertension N. Engl. J. Med., December 13, 2001; 345(24): 1778 - 1780. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Kario, J. N. Tobin, L. I. Wolfson, R. Whipple, C. A. Derby, D. Singh, P. R. Marantz, and S. Wassertheil-Smoller Lower standing systolic blood pressure as a predictor of falls in the elderly: a community-based prospective study J. Am. Coll. Cardiol., July 1, 2001; 38(1): 246 - 252. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. M. Kaplan What Is Goal Blood Pressure for the Treatment of Hypertension? Arch Intern Med, June 25, 2001; 161(12): 1480 - 1482. [Full Text] [PDF]
|
|
|
|
|
|
B. M. Psaty, C. D. Furberg, L. H. Kuller, M. Cushman, P. J. Savage, D. Levine, D. H. O'Leary, R. N. Bryan, M. Anderson, and T. Lumley Association Between Blood Pressure Level and the Risk of Myocardial Infarction, Stroke, and Total Mortality: The Cardiovascular Health Study Arch Intern Med, May 14, 2001; 161(9): 1183 - 1192. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Eigenbrodt, K. M. Rose, D. J. Couper, D. K. Arnett, R. Smith, and D. Jones Orthostatic Hypotension as a Risk Factor for Stroke : The Atherosclerosis Risk in Communities (ARIC) Study, 1987-1996 Stroke, October 1, 2000; 31(10): 2307 - 2313. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. M. Kaplan New Issues in the Treatment of Isolated Systolic Hypertension Circulation, September 5, 2000; 102(10): 1079 - 1081. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Kario, T. G. Pickering, M. Silvestrini, F. Vernieri, and P. Pasqualetti Blood Pressure Levels and Risk of Stroke in Elderly Patients JAMA, August 23, 2000; 284(8): 959 - 960. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Verdecchia, G. Schillaci, and O. R. Silvestrini J-Shaped Relation Between Blood Pressure and Stroke Hypertension, May 1, 2000; 35 (5): e15 - e15. [Full Text] [PDF]
|
|
|
|
|
|
A. Fournier, H. Mazouz, R. Oprisiu, A. Pruna, M. Andrejak, J.-M. Achard, L. Fernandez, Z. Voko, and M. M.B. Breteler Response Hypertension, May 1, 2000; 35 (5): e16 - e16. [Full Text] [PDF]
|
|
|
|
|
|
E. D. Frohlich Reappearance of the J-Shaped Curve Hypertension, December 1, 1999; 34(6): 1179 - 1180. [Full Text] [PDF]
|
|