COR LOE Recommendations In patients with hypertension who experience a stroke or TIA, treatment with a thiazide diuretic, angiotensin-converting enzyme inhibitor, or angiotensin II receptor blockers is useful for lowering BP and reducing recurrent In patients with hypertension who experience a stroke or TIA, an office BP goal of <130/80 mmHg is recommended for most patients to reduce the risk of recurrent stroke and vascu- In patients with hypertension who experience a stroke or TIA, individualized drug regimens that take into account patient comorbidities, agent pharmacological class, and patient preference are recommended to maximize In patients with no history of hypertension who experience a stroke or TIA and have an aver- age office BP of 130/80 mmHg, antihyper- tensive medication treatment can be beneficial to reduce the risk of recurrent stroke, ICH, and other vascular events.190,191,193,197 Synopsis The PAR of stroke resulting from hypertension may be as high as 50% in some racial and ethnic groups.198,199 In 2017, the AHA/ACC hypertension guideline defined hypertension as BP consistently >130/80 mmHg.29 Yet, for patients with prior stroke or TIA, there is con- cern that a possible lower BP threshold may increase the risk of stroke, or a J-curve effect. In the past, post hoc analyses of RCTs, meta-analyses, and population-based studies of patients with cerebrovascular disease have shown an inconsistent relationship between achieved SBP <120 mmHg and poor outcomes.200 204 New data from RCTs and large meta-analyses now provide com- pelling evidence that neurologically stable patients with cerebrovascular disease also benefit from a BP goal of <130/80 mmHg and that BP targets for stroke preven- tion should be more aligned with targets for prevention of other cardiovascular conditions. There is insufficient evidence to recommend a lower limit of BP within the normal range for patients with prior stroke. 