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Blood pressure and risk of stroke in patients with cerebrovascular disease

^a Clinical Trials Research Unit, Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand, ^b Neurosciences Trials Unit, Department of Clinical Neurosciences, University of Edinburgh, Edinburgh EH4 2XU

Correspondence to: Dr Rodgers.

There is widespread clinical uncertainty about lowering blood pressure in patients with ischaemic cerebrovascular disease. This often manifests as comparatively high thresholds for starting treatment and modest targets in reducing blood pressure. Concern has arisen partly from reports of a J shaped association between blood pressure and recurrent stroke in these patients.¹ This relation may, however, be because severe strokes are associated both with a fall in blood pressure² and independently with a relatively high risk of stroke recurrence, rather than from any adverse effects of low blood pressure itself. If this were true, then people with a history of minor cerebrovascular disease would have . . . [Full text of this article]

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