In Reply: We agree that, in some conditions,
hypertension may exert a protective short-term effect on stroke risk. It has
already been suggested that a drastic lowering of BP in patients with carotid
artery occlusive disease should be avoided.1
Because of this possibility, we paid careful attention to the treatment of
hypertension and aimed for target values of systolic and diastolic pressure,
respectively, in the range of 130 to 145 mm Hg and 80 to 85 mm Hg. Because
of this narrow range of BP values, we are unable to investigate the J-shaped
relationship between BP level and stroke risk in this sample. On the other
hand, verifying the possible protective effect of hypertension using BP level
as a continuous variable would have required following up hypertensive patients
without treatment. This is obviously impossible for ethical reasons.
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