Addressing the guidelines.

welcomes Letters to the Editor and will publish them, if suitable, as space permits. They should not exceed 750 words (including references) and may be subject to editing or abridgment. Please submit letters in duplicate, typed double-spaced. Include a fax number for the corresponding author and a completed copyright transfer agreement form (published in every issue). To the Editor: We commend you on the publication of these timely guidelines. 1 Increasingly, those who are involved in the care of stroke patients are heightening their focus toward prevention strategies because there are many modifiable risk factors we can tackle. There are, however, a few areas in the guidelines we would like to address. First, in the hypertension segment, the recommendation states " Because this benefit (of antihypertensive treatment) extends to persons with and without a history of hypertension, this recommendation should be considered for all ischemic stroke and TIA patients. " This recommendation is based on Class IIa, Level B evidence, presumably the PROGRESS study. 2 However, an important consideration is the definition of hypertension that was used in the PROGRESS study. As stated within the text of the guidelines, patients were classified as hypertensive if their baseline blood pressure was Ͼ160 mm Hg systolic or 90 mm Hg diastolic. The mean baseline blood pressure in the nonhypertensive group was 139/79, which according to the JNC VII, is considered prehyper-tension. 3 The JNC VII thereby recommends that patients who have had a stroke and maintain blood pressures above 120/80 should be considered for antihypertensive therapy, and references the PROGRESS study for this recommendation. However, the 2006 stroke guidelines advocate antihypertensive therapy in patients " without a history of hypertension, " which could be erroneously interpreted as applying to patients with normal blood pressure (ie, Ͻ120/80) and is not supported by the current evidence. Perhaps the authors did not intend to suggest this; however, the busy clinician scanning the recommendation sections and not closely reviewing the text may be led to believe otherwise. Second, recommendations in the diabetes segment state " ACEIs and ARBs are more effective in reducing the progression of renal disease and are recommended as first-choice medications for patients with DM ". The supporting reference for this recommendation is the 2004 ADA guidelines, the text of which actually states " Because many studies demonstrate the benefits of ACE inhibitors on multiple adverse outcomes in patients with diabetes.. . the …