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In the only large randomized trial in which researchers compared two blood pressure (BP) goals for long-term secondary prevention after stroke (<130 vs. 130–149 mm Hg), the incidence of recurrent stroke was not significantly lower with more-intensive treatment (Lancet 2013; 382:507). Now, in a study from Japan, nearly 1300 patients with recent stroke (85% ischemic, 15% hemorrhagic) and BP >130/80 mm Hg were randomized to a long-term target of <120/80 mm Hg or <140/90 mm Hg. Most patients had received hypertension treatment prior to their strokes. The study included a stepwise protocol for drug titration.
During mean follow-up of 4 years, average systolic BP was significantly lower with more-intensive than with less-intensive treatment (126.7…