In the Performance Measures of the 2008 Joint Commission Disease-Specific Care Certification Program for Stroke (http://www.jointcommission.org/2008\_Stroke\_Performance\_Measurement\_Guide\_-\_Version_2a/), it is recommended that use of nifedipine be avoided in the setting of acute stroke hospitalization. That recommendation, based largely on anecdotal evidence, is now strongly supported, and extended to ongoing care of patients at risk of stroke, by a report in this issue of Neurology ®. Jung et al.1 found that short-acting nifedipine markedly increased the risk of stroke. Among more than 2.2 million elderly hypertensive patients, 16,069 individuals were hospitalized for their first stroke in the first 6 months of 2006. Of these, 4,138 used nifedipine at least once during the study period, and they had a 4-fold increase in the risk of stroke within 7 days of initiating nifedipine therapy (2.56-fold after adjustment). The strengths of the study are that it was based on a large population, and between-individual differences were accounted for by comparing stroke risk within individuals at different times: without nifedipine, …