For adults with a lacunar stroke, a target SBP goal of less than 130 mm Hg may be IIb C-LD 7. In adults previously untreated for hypertension who experience an ischemic stroke or TIA and have a SBP less than 140 mm Hg and a DBP less than 90 mm Hg, the usefulness of initiating antihypertensive treatment is not well established.S9.4.3-9 Synopsis Each year in the United States, >750000 adult patients experi- ence a stroke, of which up to 25% are recurrent strokes.S9.4.3-10 For an individual who experiences an initial stroke or TIA, the annual risk of a subsequent or secondary stroke is approxi- and the case mortality rate is 41% after a recurrent stroke versus 22% after an initial stroke.S9.4.3-12 Among patients with a recent stroke or TIA, the prevalence of premor- bid hypertension is approximately 70%.S9.4.3-13 Risk of recurrent stroke is heightened by presence of elevated BP, and guideline- recommended antihypertensive drug treatment to lower BP has been linked to a reduction in 1-year recurrent stroke risk.S9.4.3-14 RCT meta-analyses show an approximately 30% decrease in recurrent stroke risk with BP-lowering therapies.S9.4.3-1 S9.4.3-3 An issue frequently raised by clinicians is whether the presence of clinically asymptomatic cerebral infarction incidentally noted on brain imaging (computed tomography or MRI scan) in patients without a history of or symptoms of a stroke or TIA warrants implementation of secondary stroke prevention measures. 