Effectiveness versus efficacy of treatment of hypertension for stroke prevention

It has been a privilege for me to serve as your President for the last 2 years. This office has permitted me to see the prodigious amount of work that is done so well by the chairs of the committees and the committees, which handle all of the issues before they are presented to the Executive Board. They are working on your behalf; please tell them that you appreciate their dedication. I certainly do. You probably also know what an effective staff we have in the Academy office. They, too, are dedicated, hard-working people, and when you see that a job is well done, you should tell them. I am very grateful for the help they have given me, particularly in the last 2 years. I am also grateful and indebted to my wife, Pat, who has supported me all these years, even before I was in medical school, when she was the only one of us who earned a living for more years than I like to remember.

In my presentation today, I am going to describe the population-based research resource with which I work. I will also discuss hypertension, including its relative risk for ischemic stroke, and the prevalence of hypertension and the effect of treatment. I am going to show you that, in spite of the efficacy of treatment for hypertension shown in clinical trials, we can show no evidence of effectiveness of treatment in the whole population and that the incidence of ischemic stroke has declined at least as much in persons without hypertension as in those with hypertension. Then, I will discuss some putative risks that might have a role in this decline.

The unique capabilities for population-based epidemiologic research in Olmsted County and Rochester, Minnesota, are the result of an unusual set of circumstances. …