Intensive blood pressure control in stroke survivors lowered risk of cardiovascular events

Research Highlights:

• Stroke and TIA survivors in Brazil who received medications to lower systolic blood pressure(the top number of a blood pressure reading) to less than 120 mm Hg were significantly less likely to die or have cardiovascular events within 4 years, compared to those who received standard treatment to lower levels below 140 mm Hg.
• During the four-year intervention of more than 4,000 people, more intensive blood pressure control reduced the risk of major cardiovascular events by about 21%, compared to standard treatment.
• Researchers noted that high blood pressure is the single most important modifiable risk factor for stroke, and controlling blood pressure is essential to prevent a second stroke.
• Note: This trial is simultaneously published today as a full manuscript in the peer-reviewed scientific journal New England Journal of Medicine.

Embargoed until 2:15 p.m. CT/3:15 p.m. ET, Saturday, Nov. 7, 2026

CHICAGO, Nov. 7, 2026 - More intensive treatment to lower systolic blood pressure in middle-aged adults who have already had an ischemic stroke or transient ischemic attack (TIA) significantly reduced the risk of future strokes, heart attacks and other major cardiovascular events, according to new, independent, preliminary late-breaking science presented today at the American Heart Association's Scientific Sessions 2026. The meeting on Nov. 6-9 in Chicago is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

Nearly 185,000 recurrent strokes occur in the U.S. each year. Most recurrent strokes can be avoided through lifestyle changes and controlling risk factors such as high blood pressure, poor diet, inactivity, smoking, and obesity, according to 2021 American Heart Association/American Stroke Association Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack.

"Controlling blood pressure after a stroke is especially important because it can help prevent another stroke, prevent other cardiovascular complications and protect patients' lives," said the study's steering committee chair and senior author Otavio Berwanger, M.D., Ph.D., chair of the OPTIMAL study Steering Committee and executive director at The George Institute for Global Health in London and chair in clinical trials at Imperial College London, UK.

"Our study shows that for many people who have already experienced an ischemic stroke or TIA, aiming for a systolic blood pressure below 120 mm Hg can provide additional cardiovascular protection compared with the conventional target of below 140 mm Hg. However, we emphasize that achieving lower blood pressure safely requires appropriate medical supervision and additional monitoring, particularly of kidney function," said the study's principal investigator, Gisele Sampaio, M.D., Ph.D., M.Sc., a professor of neurology at the Federal University of São Paulo and head of neurology clinical research at the Albert Einstein Hospital in São Paulo, Brazil.

The American Heart Association/American College of Cardiology Joint 2025 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults recommends maintaining systolic blood pressure under 130 mm Hg and diastolic blood pressure (the bottom number) less than 80 mm Hg; and encourages blood pressure measures less than 120 mm Hg for people at increased risk for cardiovascular disease.

The study, called Intensive Blood-Pressure Control for the Prevention of Major Cardiovascular Events in Patients With Prior Stroke: The OPTIMAL-Stroke Trial, investigated the optimal blood pressure target to prevent a recurrent stroke. The trial, conducted at 30 health centers in Brazil, with patients enrolled between 2019 and 2022, evaluated the impact of intensive antihypertensive treatment on the incidence of cardiovascular death, heart attack, stroke and other major cardiovascular events, including hospitalization for unstable angina (chest pain) or heart failure. Study participants had previously experienced an ischemic stroke or TIA and had elevated blood pressure between 130 and 180 mm Hg.

What are the key findings of the study?

• During the four-year intervention, participants in the intensive blood pressure-lowering group were about 21% less likely to experience a major cardiovascular event than participants in the standard treatment group.
• Cardiovascular events occurred in 236 participants (10.9%) on intensive therapy and in 297 participants (13.5%) on standard therapy.
• Participants in the intensive therapy group had a lower rate of recurrent strokes when compared to those in the standard treatment group, 4.7% versus 6.4%, respectively. The difference was driven by fewer ischemic strokes in the intensive therapy group.
• Serious adverse events were similar in both groups. However, the increase in kidney-related events in the intensive treatment group highlights the importance of individualized treatment and careful monitoring, researchers said.

"High blood pressure is the single most important modifiable risk factor for stroke, and controlling blood pressure is essential to prevent another stroke," Sampaio said.

"For stroke survivors, it's important to take three steps: know your blood pressure, take your prescribed medications consistently and discuss your individual blood pressure target with your healthcare team. A lower blood pressure target may offer greater protection, and we must ensure that the right target is achieved safely and tailored to each patient."

What are the study's details, background, design and limitations?

• The OPTIMAL-STROKE trial, conducted between 2019 and 2022 at 30 health centers in Brazil, enrolled 4,368 men and women who had an ischemic stroke or a transient ischemic attack (TIA, also known as a "mini" stroke). The study participants were average age 64; 47.9% were women; 56.8% self-identified as white adults; 29.8% as mixed-race adults and 12.1% as Black adults.
• At time of enrollment in the study, participants' average systolic blood pressure was 146.7 mm Hg, and average diastolic blood pressure was 81.6 mm Hg.
• Participants were randomly divided into two groups: one group received intensive blood pressure treatment with a target systolic blood pressure of less than 120 mm Hg, and the other group received standard treatment with a target systolic blood pressure of less than 140 mm Hg.
• Over an average of 3.9 years of follow up, researchers tracked whether participants died from cardiovascular disease, had a heart attack or stroke, or were hospitalized for unstable angina or heart failure.
• One important limitation of the study is that not all patients in the intensive therapy group achieved the target of systolic blood pressure below 120 mm Hg. Additionally, the results may not be generalizable to people not living in Brazil, where healthcare access and options and environmental factors are different.

Co-authors, disclosures and funding sources are listed in the abstract.

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Additional Resources:

• Multimedia is available on the right column of the release link
• View the abstract in the American Heart Association Scientific Sessions 2026 Online Program Planner
• American Heart Association news release: Managing high blood pressure could prevent >500K CVD deaths annually in 20 countries (Oct. 2026)
• American Heart Association news release: New high blood pressure guideline emphasizes prevention, early treatment to reduce CVD risk (Aug. 2025)
• American Heart Association/American Stroke Association health information: Preventing Another Stroke
• American Heart Association health information: Understanding Blood Pressure Readings
• About Scientific Sessions 2026
• For more news at the American Heart Association's Scientific Sessions 2026, follow us on X @HeartNews, #ScientificSessions26

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