SUMMARY A sample of 99 elderly (over age sixty) adults with isolated systolic hypertension were examined for cervical arterial bruits and systolic blood pressure measurements were taken in upper and lower extremities. The ratio of ankle to arm blood pressure (ankle/arm index) was used as a measure of the degree of obstruction in peripheral arterial circulation. The prevalence of bruit (asymptomatic in all cases) was high, with 24 bruits detected in 19 (19%) participants. This high prevalence of bruits is thought to be due to the blood pressure characteristics of this population. Those with bruit were found to have a 3.9 times greater chance of having an abnormal ankle/arm index. The relationship remained statistically significant even after controlling for the effects of age and smoking. These findings add further evidence to the hypothesis that asymptomatic cervical bruits are an indication of systemic vascular disease. Stroke Vol 16, No 5, 1985THE RISK OF STROKE for persons with asymptomatic carotid bruit continues to be a very controversial topic. Two recent prospective studies have provided data suggesting that asymptomatic carotid bruits increase the risk of stroke between 1.6 and 7.5 fold.1 2However, correlation between location of the carotid bruit and type of subsequent stroke was poor. Myocardial infarction also occurred more frequently and to a degree similar to that observed for stroke. In general, mortality, particularly cardiovascular mortality, was notably higher in persons with asymptomatic carotid bruit. The frequency of carotid bruits has been found to be more than twice as high in persons with systolic hypertension as in normals.2 High systolic blood pressure has also been associated with other forms of vascular disease, including peripheral arterial stenosis.3 Little information however has been reported about the relationship between carotid bruits and peripheral arterial stenosis. The current research was designed to investigate this relationship in a group of 1.09 elderly (over age sixty) men and women with isolated systolic hypertension. MethodsThe subjects involved in the current investigation were participants enrolled in the Systolic Hypertension in the Elderly Program (SHEP), a multi-center clinical trial designed to test the efficacy of treatment of systolic hypertension in an elderly population. Screening for this study took place at shopping malls, retirement centers, churches, senior citizens' clubs and other locations where predominantly healthy elderly adults could be found. Qualifications for entry into the study included an age of 60 or above, systolic pressure greater than or equal to 160 and diastolic blood pressure less than 90. Exclusions for entry were as follows:1) Current treatment with antihypertensive medications.