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(Stroke. 2006;37:1968.)
© 2006 American Heart Association, Inc.

Letters to the Editor

Response to Letter by Mysak et al

Ralph L. Sacco, MS, MD, FAAN, FAHA

Stroke and Critical Care Division, Neurological Institute, Columbia University, New York, NY

Larry B. Goldstein, MD, FAAN, FAHA

Duke Center for Cerebrovascular Disease, Center for Clinical Health Policy Research, Duke University Medical Center, Durham, NC

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Response:

We appreciate the thoughtful comments from Drs Mysak and Tulloch. We agree that the definition of hypertension used in the PROGRESS trial was a systolic blood pressure 160 mm Hg or a diastolic blood pressure 90 mm Hg.¹ Those with blood pressures below this threshold were classified as nonhypertensive based on older definitions. As correctly pointed out by Drs Mysak and Tulloch, the mean blood pressure in this "non-hypertensive" group of 136/79 mm Hg is in the "pre-hypertension" range (120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic) as defined by JNC-VII.² Although the standard deviations and range of blood pressures in the "non-hypertensive" group are not given in the PROGRESS trial report, as this is a mean value, the group likely includes subjects who would be classified as having "normal" blood pressures. The recommendation, "Because this benefit extends to persons with and without a history of hypertension, [treatment] should be considered for all ischemic stroke and TIA patients (Class IIa, Level of Evidence B)" is appropriate and reflects the available evidence. This statement, however, needs to be qualified by the recommendation that follows. "An absolute target BP level and reduction are uncertain and should be individualized, but benefit has been associated with an average reduction of 10/5 mm Hg, and normal BP levels have been defined as <120/80 mm Hg by JNC-7 (Class IIa, Level of Evidence B)." Given the stated normal BP of 120/80 mm Hg, we did not mean to imply that . . . [Full Text of this Article]

Related Article:

Addressing the Guidelines

Tania Mysak and Karen Tulloch
Stroke 2006 37: 1967. [Extract] [Full Text] [PDF]