To the Editor.— Two statements in the recent report by "The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure"1 give cause for concern, with respect to neurological patients. The first is that following acute ischemic cerebral infarction or transient ischemic attacks, "antihypertensive therapy may be withheld temporarily to avoid critical reduction in cerebral perfusion unless the diastolic blood pressure is very high (greater than 105 mm Hg)." The article gives no guidelines regarding how and to what degree the blood pressure should be lowered. In my experience, many physicians arbitrarily "normalize" the blood pressure to about 120/80 mm Hg or even lower, probably because treatment of chronic hypertension (diastolic pressure greater than 105 mm Hg) reduces the incidence of stroke in the long term. Patients with acute stroke usually have had chronic hypertension, often untreated, and consequently have higher limits of cerebral autoregulation than normal.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.