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Optimal blood pressure target for patients with prior stroke: A systematic review and meta-analysis

Toshiki Maeda1, Yuichiro Ohya2, Shintaro Ishida3

  • 1Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. tmaeda@fukuoka-u.ac.jp.

Hypertension Research : Official Journal of the Japanese Society of Hypertension
|March 18, 2025
PubMed

Insights

Intensive blood pressure control (systolic BP <130 mmHg) significantly reduces recurrent stroke and cardiovascular events in patients with prior stroke. While intensive control increases dizziness, the benefits outweigh this risk, supporting a lower target for stroke prevention.

Area of Science:

  • Cardiology
  • Neurology
  • Clinical Trials

Background:

  • Optimal blood pressure (BP) management is crucial for secondary stroke prevention.
  • Previous guidelines suggested a systolic BP (SBP) target <140 mmHg for patients with a history of stroke.

Purpose of the Study:

  • To systematically review and meta-analyze randomized controlled trials (RCTs) comparing intensive BP control (SBP <130 mmHg) versus standard BP control (SBP <140 mmHg) in patients with prior stroke.
  • To evaluate the efficacy and safety of intensive BP targets for reducing recurrent stroke and major cardiovascular events.

Main Methods:

  • Systematic literature search of PubMed/MEDLINE, Cochrane Database, and Ichu-shi.
  • Inclusion of seven RCTs for quantitative meta-analysis using random-effects models.
  • Assessment of risk of bias for included trials.

Main Results:

  • Intensive BP control significantly reduced recurrent stroke (RR, 0.79; 95% CI, 0.65-0.96) and major cardiovascular events (RR, 0.86; 95% CI, 0.76-0.97).
  • Intensive control was more effective for hemorrhagic stroke (RR, 0.33; 95% CI, 0.15-0.74) than ischemic stroke (RR, 0.87; 95% CI, 0.71-1.08).
  • Adverse events like syncope and dizziness were more frequent with intensive control (RR, 1.30; 95% CI, 1.00-1.68), but absolute risk reduction for stroke and CV events outweighed this increase.

Conclusions:

  • A lower SBP target of <130 mmHg is recommended for patients with prior stroke.
  • This intensive BP control strategy effectively prevents recurrent stroke and major cardiovascular events.
  • Careful monitoring for hypotension-related symptoms is advised when implementing intensive BP control.

Keywords:
Intensive blood pressure controlOptimal blood pressure targetStrokeSystematic review

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