Elevated Midlife Blood Pressure Increases Stroke Risk in Elderly Persons

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Abstract
STROKE IS the leading neurological cause of mortality and morbidity worldwide. The annual incidence of stroke in the United States has been estimated at more than 600 000.1 The most important modifiable risk factor for stroke is an elevated blood pressure (BP),2 and this fact is recognized in stroke risk prediction models, developed by the Framingham Study researchers and adopted by the American Stroke Association.1,3 These risk prediction models, however, consider the BP at the time of risk prediction (current BP) but do not adjust for the potential impact of BP levels experienced by individuals in the past (antecedent or past BP). Some investigators4 have suggested that consideration of the current BP provides adequate information for predicting stroke risk, and in clinical trials,5 most of the stroke prevention effect of lowering BP is achieved within a few years of starting treatment. On the other hand, some of the known stroke risk factors in observational studies, such as the presence of electrocardiographic left ventricular hypertrophy3,6 and increased echocardiographic left ventricular mass,7 are related to long-term elevations of BP. In addition, midlife BP has been shown to be predictive of the degree of carotid stenosis (a direct precursor of atherothrombotic stroke) in elderly persons.8