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Recurrent stroke

More than 30% of strokes occur after a previous stroke or transient ischaemic attack (TIA) so secondary prevention is important in reducing morbidity and costs of care.

Hypertension is a main risk factor in stroke. A 20mmHg difference in usual systolic blood pressure is associated with a 60% lower risk of death from stroke in someone aged 50-70 years and a 50% lower risk in someone aged 70-79.

In this trial, management of patients given an intensive blood pressure target below 130mmHg was compared with the management of patients given the standard target of less than 140mmHg.

The researchers found that the intensive group achieved only a small additional difference of 3mmHg and that achieving this required significant extra resources and greater burden for patients.

Both arms of the study showed a reduction in blood pressure, which suggests that the most important consideration is that blood pressure should be actively managed after stroke or TIA.

The researchers conclude that the additional money required for intensive treatment could be better spent increasing the proportion

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