With 1 excep- tion, the reports are consistent with supporting better stroke outcomes with BPs <130/80 mmHg. The exception is a post hoc observational analysis of the Prevention Regimen for Effectively Avoiding Second Strokes (PROFESS) data, involving 20 330 patients with recent ischemic stroke. Hypertension was not an inclusion criterion, although most of the patients had elevated BP. PROFESS was also not a clinical trial of antihypertensive therapy but primarily of antiplatelet agents. During the 2.5 years of follow-up, the adjusted hazard ratio for subjects with an SBP in the 120- to 129-mm Hg range, compared with those in the 130- to 139-mm Hg range, was 1.10 (95% confidence interval, 0.95 1.28) for stroke and 1.01 (95% confidence interval, 0.64 1.89) for fatal stroke, both not statistically significant, and 1.16 (95% confidence interval, 1.03 1.31) for a composite end point of stroke, MI, or vas- In a very large meta-analysis of 147 randomized trials of the percentage reductions in coro- nary heart disease events and stroke were similar in people with and without CVD and regardless of BP before treatment (down to 110 mmHg SBP and 70 mmHg DBP). A meta- regression analysis that included 31 intervention trials of BP lowering in 74000 patients with diabetes mellitus reported a decrease of 13% in the risk of stroke for each 5-mmHg reduc- tion in SBP and of 11.5% for each 2-mmHg reduction in DBP. In contrast, the decrease in the risk of MI approached but did not achieve statistical significance.157 In ONTARGET, the benefits from lowering SBP to <130 mmHg were driven mostly by a reduction in stroke. 