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(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
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