An indepen- dent Cochrane analysis185 of SPS3, PAST-BP, and PODCAST (done before RESPECT publication) reported a trend toward benefit of intensive BP CLINICAL STATEMENTS AND GUIDELINES Kleindorfer targets (pooled RR for recurrent stroke, 0.80 [95% CI, 0.63 1.00]). In addition, the largest meta-analy- sis to date including >40000 patients from 14 RCTs showed a significantly lower rate of recurrent stroke in patients with an achieved SBP of <130 mg Hg compared with higher SBP groups.194 It should be noted that for patients with intracranial large artery atherosclerosis, a higher BP target may be appropri- ate (see Section 5.1.1). 3. The magnitude of BP lowering appears to be more important for risk reduction than the class of antihypertensive agent used.188,189,195,196 Therefore, individual patient characteristics that may affect the safety and efficacy of treatment (eg, T2D, chronic kidney disease, AF) should be taken into account in the selection of antihyper- tensive agents. 4. The recommended threshold BP of >130/80 mmHg for starting antihypertensive medications is informed by the baseline BPs of patients with cerebrovascular disease studied in trials of BP treatment. Among the 4 RCTs comparing inten- sive and standard BP targets in patients with prior cerebrovascular disease, the RESPECT190 , trials included patients with baseline SBPs as low as 125 mmHg. 50% of patients had baseline SBP <140 mmHg. Similarly, in the PRoFESS trial (Prevention Regimen for Effectively Avoiding Second Strokes) of >20000 patients with isch- 33% of patients had baseline SBP <135 mmHg. 