Blood pressure and cerebral ischemia: A continuing dilemma

Classical neurologic teaching suggests that a higher cerebral systemic blood pressure (BP) be targeted for individuals with occlusive carotid disease, in order to improve cerebral perfusion through collaterals. This conflicts, however, with observational population-based studies and clinical trials supporting better outcomes associated with lower BPs. In this issue of Neurology®, Powers et al.1 evaluate nonsurgical controls from the Carotid Occlusion Surgery Study (COSS) and report lower rates of stroke recurrence in individuals maintained at a follow-up BP of 130/85 mm Hg or lower