J-shaped relation between blood pressure and stroke in treated hypertensives

The objective of this study was to investigate the relationship between hyp ertension and risk of stroke in the elderly. The study was performed within the framework of the Rotterdam Study, a prospective population-based cohor t study. The risk of first-ever stroke was associated with hypertension (re lative risk, 1.6; 95% CI, 1.2 to 2.0) and with isolated systolic hypertensi on (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 a nd 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 st rong risk factors for stroke in the elderly, The increased stroke risk in t he lowest stratum of blood pressure in treated hypertensive patients may in dicate that the therapeutic goal of "the lower the better" is not the optim al strategy in the elderly.