ABSTRACT
A contentious area of blood pressure (BP)-lowering treatment in chronic post-stroke phase is the risks and benefits in patients with severe large artery occlusive diseases. BP-lowering treatment is likely to be the single most important stroke prevention strategy. This chapter reviews the results obtained from the randomised controlled trials, focusing on BP-lowering treatment for secondary prevention of stroke. With regard to optimal target BP, large-scale observational studies have demonstrated clear associations between BP and initial stroke. A systematic review of observational studies performed by the Prospective Studies Collaboration demonstrated that lower BP levels are continuously associated with lower risks of fatal stroke down to very low BP levels. There are also a few randomised controlled trials which investigated the benefits and harms of intensive BP lowering towards lower systolic BP levels in secondary prevention of stroke. BP-lowering treatment provides the only proven strategy for the secondary prevention of intracerebral haemorrhage.
