Diastolic blood pressure levels and ischemic stroke incidence in older adults with white matter lesions

Shoshana Reshef, Linda Fried, Norman Beauchamp, Daniel Scharfstein, Daniel Reshef, Steven Goodman

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: The optimal blood pressure level to minimize the risk of ischemic stroke (IS) in older adults is undetermined. Cerebral white matter lesions (WML), prevalent in older adults, may be a marker for vulnerability to IS. We aimed at determining the relationship between diastolic blood pressure (DBP) levels and IS in the presence of WML. Methods: The Cardiovascular Health Study population (N = 3,345, age ≥ 65 years, N = 3,345) was followed between 1989 and 2002 for IS incidence. Survival analysis included quintiles of DBP analyzed within WML levels controlling for age and cardiovascular disease. Results: DBP had no effect on IS incidence in low WML levels but had a marginally significant J-curve relationship with IS in high WML levels: the adjusted hazard ratio for IS in the lowest (≤63 mmHg) and highest (≥80) DBP quintiles compared with the third (nadir, 69-73 mmHg) was 1.64 (95% confidence interval: 0.93-2.9) and 1.83 (95% confidence interval: 1.06-3.15), respectively. Conclusions: In older adults with low-grade WML, low DBP may not pose a risk for IS. However, in high-grade WML, IS risk may increase in DBP less than 69 mmHg but is highest more than 80 mmHg. People with high-grade WML may be at risk of IS in high and low DBP.

Original languageEnglish (US)
Pages (from-to)74-81
Number of pages8
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume66 A
Issue number1
StatePublished - Jan 2011
Externally publishedYes


  • Blood pressure
  • Cardiovascular Health Study
  • Ischemic stroke
  • White matter lesions

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology


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