In a meta-analysis of 16 trials involving 70664 prehypertensive patients, prehyperten- sive patients randomized to active antihypertensive treatment had a consistent and statistically significant 22% reduction in the risk of stroke compared with those taking placebo Behavioral lifestyle changes are recommended by the Seventh Joint National Committee as part of a comprehen- sive treatment strategy for hypertension.221 Compelling evi- dence from >40 years of clinical trials has documented that drug treatment of hypertension prevents stroke and other BP-related target-organ damage, including heart failure, coro- nary heart disease, and renal failure.221 A meta-analysis of 23 randomized trials showed that antihypertensive drug treatment reduced the risk of stroke by 32% (95% CI, 24 39; P=0.004) compared with no drug treatment.230 The use of antihyper- tensive therapies among those with mild hypertension (SBP, 140 to 159 mmHg; DBP, 90 to 99 mmHg; or both), however, was not clearly shown to reduce the risk of first stroke in a Cochrane Database Systematic Review, although a trend of clinically important magnitude was present (RR, 0.51; 95% CI, 0.24 1.08). Because 9% of patients stopped therapy as a result of side effects, the authors recommended further trials Several trials have addressed the potential role of antihy- pertensive treatment among patients with prevalent CVD but without hypertension. In a meta-analysis of 25 trials of antihy- pertensive therapy for patients with prevalent CVD (including stroke) but without hypertension, patients receiving antihyper- tensive medications had a pooled RR for stroke of 0.77 (95% CI, 0.61 0.98) compared with control subjects.232 The magni- tude of the RR reduction was greater for stroke than for most other cardiovascular outcomes, although the absolute risk reductions were greater for other outcomes because of their greater relative frequency. 