Targeting a systolic blood pressure (BP) of less than 120 mm Hg lowered the incidence of major cardiovascular events compared with a target of less than 140 mm Hg among participants with elevated BP and a previous ischemic stroke or transient ischemic attack, according to a multicenter, open-label, randomized trial conducted at 30 sites in Brazil. In the trial, 4368 participants (mean age, 63.9 years; 47.9% women) were assigned to intensive treatment (2172 participants) or standard treatment (2196 participants); during follow-up excluding the first 3 months, mean systolic BP was 122.0 mm Hg in the intensive group versus 135.2 mm Hg in the standard group, a between-group difference of 13.1 mm Hg. Over a median follow-up of 3.9 years, a primary-outcome event—a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina or heart failure—occurred in 236 participants (10.9%; 3.25 events per 100 person-years) with intensive treatment and in 297 (13.5%; 4.11 events per 100 person-years) with standard treatment (hazard ratio, 0.79). The composite renal outcome (sustained reduction of ≥50% in the estimated glomerular filtration rate or progression to end-stage renal disease) was more common with intensive treatment, while the overall incidence of serious adverse events was similar in the two groups, suggesting that intensive BP control may offer cardiovascular benefit in this population despite the renal signal. Source: https://www.nejm.org/
