In PROGRESS, treatment with perindopril (4 mg daily) and indapamide reduced base- line BP by an average of 12 mmHg systolic and 5 mmHg dia- stolic and lowered the risks of first and recurrent ICH (adjusted respectively), as well as other vascular events.267,273,279 In that trial, the lowest risk of stroke recurrence was seen among patients with the lowest follow-up BP levels (median, 112 mmHg systolic and 72 mmHg diastolic) 280 ; those with prior ICH derived the greatest benefit, and the size of the benefit was directly related to the degree of BP lowering, with no clear evidence of a lower threshold below which the benefit attenuated or even reversed, as is seen for ischemic stroke or coronary artery disease. Results of the Secondary Prevention of Small Subcortical Strokes (SPS3) study have shown that the greatest benefit of more intensive BP lowering is on the prevention of ICH in patients with established small-vessel stroke disease and that lowering target SBP to <130 mmHg significantly reduced the risk of ICH (risk reduction, 60%; which suggests that ICH patients should have their BP lowered to or beyond the targets currently rec- ommended in other high-risk groups (<130 mmHg systolic and 80 mmHg diastolic in the presence of diabetes mellitus, heart failure, or chronic kidney disease).282 Other factors, such as BP variability, the presence of obstructive sleep apnea,283,284 obesity, and other lifestyle modifications, should also be considered despite the lack of systematic data regarding their effect on ICH recurrence. Frequent alcohol use (>2 drinks per and illicit drug use have been linked to elevated BP and and should be avoided in ICH patients. Tobacco use is also associated with increased ICH risk287 291 and should be discontinued. The optimal timing for initiating BP lowering after ICH to prevent recurrence is unknown. 