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To the Editor: Dr Silvestrini and colleagues¹ reported a positive association between cerebral vasoreactivity and risk of stroke in patients with asymptomatic carotid artery stenosis of at least 70%. Previously, stroke risk has been thought to increase linearly with increasing blood pressure (BP). However, 2 recent studies^2-3 have suggested that there may be a J-curve relationship between BP level and stroke risk in elderly people so that not only is there an increase in stroke risk with increasing BP level, but also an increasing risk below some specific BP value.

In the first report,² a subanalysis of the Systolic Hypertension in the Elderly Program (SHEP), it was shown that in the active treatment group, a decrease in diastolic BP below 70 mm Hg increased the risk of stroke, coronary heart disease, and cardiovascular disease. In the second study,³ an observational study of elderly patients with hypertension, a J-curve relationship was . . . [Full Text of this Article]

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RELATED ARTICLE

Impaired Cerebral Vasoreactivity and Risk of Stroke in Patients With Asymptomatic Carotid Artery Stenosis
Mauro Silvestrini, Fabrizio Vernieri, Patrizio Pasqualetti, Maria Matteis, Francesco Passarelli, Elio Troisi, and Carlo Caltagirone
JAMA. 2000;283(16):2122-2127.
ABSTRACT | FULL TEXT