AHA: More intensive blood pressure lowering cuts future cardiovascular risk after stroke, transient ischemic attack

by Elana Gotkine

edited by Gaby Clark, reviewed by Andrew Zinin

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For adults with previous ischemic stroke or transient ischemic attack, targeting a systolic blood pressure <120 mmHg versus <140 mmHg yields a lower incidence of major cardiovascular events, according to a study published online Nov. 7 in the New England Journal of Medicine to coincide with the American Heart Association Scientific Sessions 2026, held from Nov. 6 to 9 in Chicago.

Gisele Sampaio Silva, M.D., M.P.H., Ph.D., from the Hospital Israelita Albert Einstein in São Paulo, Brazil, and colleagues conducted a multicenter, randomized trial at 30 sites involving participants with elevated blood pressure and previous ischemic stroke or transient ischemic attack. Participants were randomly assigned to receive intensive treatment targeting a systolic blood pressure <120 mmHg or to receive standard treatment targeting a systolic blood pressure of <140 mmHg (2,172 and 2,196 individuals, respectively).

The researchers found that during the follow-up period, excluding the first three months, the mean systolic blood pressure was 122.0 ± 11.5 and 135.2 ± 9.7 mmHg in the intensive-treatment and standard-treatment groups, respectively, with a mean difference of 13.1 mmHg between the groups. A primary outcome event (composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina or heart failure) occurred in 10.9% and 13.5% of patients in the intensive-treatment and standard-treatment groups, respectively, during a median follow-up of 3.9 years (3.25 versus 4.11 events per 100 person-years; hazard ratio, 0.79).

With intensive treatment, the composite renal outcome (sustained reduction of ≥50% in the estimated glomerular filtration rate or progression to end-stage renal disease) was more common. The groups had a similar overall incidence of serious adverse events.

"We emphasize that achieving lower blood pressure safely requires appropriate medical supervision and additional monitoring, particularly of kidney function," Sampaio said in a statement.

Several authors disclosed ties to the biopharmaceutical industry.

Publication details

Gisele Sampaio Silva et al., Intensive Blood-Pressure Control in Patients with Previous Ischemic Stroke, New England Journal of Medicine (2026). DOI: 10.1056/nejmoa2612924

More Information

Journal information: New England Journal of Medicine

Key medical concepts

Transient Ischemic AttackIschemic StrokeCardiovascular Risks

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NeurologyCardiology Who's behind this story?

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