Similarly, women may have a higher risk of first stroke with hypertension. For example, the INTERSTROKE study showed that women had a higher risk of stroke with self- reported blood pressures (BPs) of 160/90 mmHg (odds ratio 3.22 4.68), although the CIs overlapped.92 In addition, older women (mean age 63 years) with prehypertension had a 93% increased risk of stroke compared with normotensive women in the Women s Health Initiative (WHI) cohort, which implies that early and sustained treatment of hypertension is critical.93 Efficacy of Hypertension Treatment and Reduction of Stroke in Women The effects of pharmacological intervention to lower BP and thereby reduce the risk of stroke on cardiovascular outcomes and surrogate cardiovascular end points have been studied and women have been well represented in large clinical trials of antihypertensive therapy; however, no trials have specifically examined a differential effect of phar- macological BP treatment in men and women on stroke events. Similarly, post hoc analyses and meta-analyses of clinical trial data have not reported sex differences in response to treat- ment or stroke events. In a recent meta-analysis of 31 large, randomized BP trials, treatment of hypertension in women aged >55 years (90% of whom were white) was associated with a 38% risk reduction in fatal and nonfatal cerebrovascu- lar events (95% CI, 27% 47%). A reduction of 25% in fatal and nonfatal cardiovascular events (95% CI, 17% 33%) was Figure 2. Female-male US stroke mortality ratio, 2009. Am Indian indicates American Indian; Non-Hisp, non-Hispanic; and PI, Pacific Islander. 