Lower Blood Pressure Target Cuts Events After Stroke
A trial of 4,368 stroke survivors found that aiming for systolic blood pressure below 120 lowered major cardiovascular events to 10.9 percent, versus 13.5 percent.
More intensive treatment to lower systolic blood pressure in middle-aged adults who have already had an ischemic stroke or a transient ischemic episode, known as a TIA, significantly reduced the risk of future strokes and other major cardiovascular events, in a study of a blood pressure target stroke survivors goal, according to research presented on November 7 at the American Heart Association Scientific Sessions 2026 in Chicago and published in the New England Journal of Medicine. The study, called OPTIMAL-STROKE, investigated the best blood pressure target to prevent a recurrent stroke.
The trial was conducted at 30 health centers in Brazil, with patients enrolled between 2019 and 2022. It enrolled 4,368 men and women who had an ischemic stroke or a TIA, and it compared an intensive systolic target below 120 mm Hg with a standard target below 140 mm Hg. Over a median follow-up of 3.9 years, the primary composite outcome, which included cardiovascular death, stroke, a cardiac event, and hospitalization for unstable angina or heart failure, occurred in 10.9 percent of patients in the intensive group, compared with 13.5 percent in the standard group, a hazard ratio of 0.79.
Benefits and risks of the blood pressure target stroke survivors goal
The American Heart Association and American College of Cardiology joint 2025 guideline recommends maintaining systolic blood pressure under 130 mm Hg and diastolic pressure under 80 mm Hg, and encourages a level under 120 mm Hg for people at increased risk of cardiovascular disease. The new trial supports a lower target for stroke survivors, but it also found trade-offs. Serious adverse events were similar in the two groups, at 15.1 percent versus 15.3 percent, but renal outcomes were more frequent with intensive treatment, at 3.9 percent versus 2.2 percent, and low sodium was also more frequent, at 3.3 percent versus 2.2 percent.
The investigators cited the open-label design, enrollment limited to Brazil, and reduced statistical power after sample size revisions as limitations, so the results may not apply in the same way to every population. A related trial in people with type 2 diabetes, OPTIMAL-DIABETES, found no clear benefit from the same lower target, showing that the best goal may differ by patient group. Stroke survivors should discuss blood pressure targets, kidney function, and medication choices with a clinician, rather than changing treatment on the basis of a single trial.
Source: HCPLive
