Framingham Study Insights on the Hazards of Elevated Blood Pressure

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Epidemiologic Assessment of the Role of Blood Pressure in Stroke: The Framingham Study

William B. Kannel, MD, Philip A. Wolf, MD, Joel Verter, MS, and Patricia M. McNamara

JAMA. 1970;214(2):301–310.

Control of hypertension whether labile or fixed, systolic or diastolic, and at any age or in either sex, appears to be central to the prevention of atherothrombotic brain infarction (ABI). Prospectively, hypertension proved to be the most common and potent precursor of ABIs. Its contribution was direct and could not be attributed to factors related both to stroke and hypertension. Asymptomatic, casual hypertension was associated with a risk of ABI about 4 times that of normotensive individuals. The probability of occurrence of an ABI was predicted no better with both blood pressure measurements or the mean arterial pressure than with systolic alone. Since there was no diminishing impact of systolic blood pressure with advancing age, the concept that systolic elevations are, even in the aged, innocuous is premature. When normotensive and hypertensive individuals were compared in each sex, women did not tolerate hypertension better than men.

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