Journal of Gerontology: MEDICAL SCIENCES Cite journal as: J Gerontol A Biol Sci Med Sci doi:10.1093/gerona/glq166

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Diastolic Blood Pressure Levels and Ischemic Stroke Incidence in Older Adults With White Matter Lesions Shoshana Reshef,1 Linda Fried,2 Norman Beauchamp,3 Daniel Scharfstein,4 Daniel Reshef,5 and Steven Goodman1 1Department

of Epidemiology, Johns Hopkins Bloomberg School of Public Health. School of Public Health, Columbia University. 3Department of Radiology, University of Washington. 4Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health. 5Drug Safety Risk Management, Hoffmann-La Roche. 2Mailman

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 (