Clinically asymptomatic vascular brain injury is increasingly being considered as an entry point for secondary stroke preven- tion therapies, because these apparently silent brain infarctions are associated with typical stroke risk factors, accumulatively lead to subtle neurological impairments, and bolster risk of future symptomatic stroke events.S9.4.3-15 Although the evidence for using antihypertensive treatment to prevent recurrent stroke in stroke patients with elevated BP is compelling,S9.4.3-1 S9.4.3-3 questions remain about when precisely after an index stroke to initiate it, what specific agent(s) to use (if any), which therapeu- tic targets to aim for, and whether the treatment approach should vary by index stroke mechanism and baseline level of BP.S9.4.3-16 Figure 9 is an algorithm on management of hypertension in patients with a previous history of stroke (secondary stroke prevention). Recommendation-Specific Supportive Text 1. Two overviews of RCTs published through 2009 showed that antihypertensive medications lowered the risk of recurrent vascular events in patients with stroke or 2. Specific agents that have shown benefit in either dedi- cated RCTs or systematic reviews of RCT data include diuretics, ACE inhibitors, and ARBs. 3. Support for this recommendation is based on data from 2 dedicated RCTs, as well as a systematic review and meta-analysis, among patients with a history of stroke or 4. Reduction in BP appears to be more important than the choice of specific agents used to achieve this goal. Thus, if diuretic and ACE inhibitor or ARB treatment do not achieve BP target, other agents, such as CCB and/or mineralocorticoid receptor antagonist, may be added. 5. An overview of RCTs showed that larger reductions in SBP tended to be associated with greater reduction in risk of recurrent stroke. 