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  • JSH2025 Systematic Review Series: Clinical Questions in the Management of Hypertension
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Optimal blood pressure target for patients with prior stroke: A systematic review and meta-analysis

Hypertension Research volume 48, pages 1859–1869 (2025)Cite this article

Abstract

In this systematic review of randomized controlled trials, we examined the optimal blood pressure (BP) target for patients with prior stroke, comparing intensive BP control (systolic BP [SBP] <130 mmHg) with standard BP control (SBP < 140 mmHg). Literature searches of PubMed/MEDLINE, the Cochrane Database, and Ichu-shi identified seven randomized controlled trials for quantitative analysis. Meta-analyses were performed using random-effects models, with most included trials assessed as having low risks of bias. The meta-analysis showed significant reductions in recurrent stroke (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65–0.96) and major cardiovascular events (RR, 0.86; 95% CI, 0.76–0.97) in the intensive BP control arm. Intensive BP control was more effective in reducing recurrent hemorrhagic stroke (RR, 0.33; 95% CI, 0.15–0.74) than ischemic stroke (RR, 0.87; 95% CI, 0.71–1.08). However, adverse events such as syncope or dizziness were significantly more frequent in the intensive BP control arm (RR, 1.30; 95% CI, 1.00–1.68). Absolute risk reductions (per 1,000 persons) for recurrent stroke (−14; 95% CI, −24 to −4) and major cardiovascular events (−17; 95% CI, −28 to −6) outweighed the absolute increase in syncope or dizziness (4; 95% CI, 0–9). We recommend a lower SBP target of <130 mmHg, with careful monitoring for hypotension-related symptoms, to prevent recurrent stroke and major cardiovascular events in patients with prior stroke.

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Acknowledgements

This study is a report of the Japanese Society of Hypertension Task Force on the Guidelines for Management of Hypertension 2025 (JSH2025). TM and SI contributed to developing the search strategy and conducting the searches. TM, YO, SI, YI, TF, YS, NO, and TN participated in the initial and full-text screenings. TM, SI, and YI were responsible for extracting relevant results and evaluating the risk of bias. HA, KT, HK, and MK supervised the study and provided valuable feedback. TM drafted the initial manuscript, and all authors critically revised subsequent drafts to ensure inclusion of crucial intellectual content. All authors approved the final version of the manuscript for publication. We thank Angela Morben, DVM, ELS, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

This work was supported by JSPS KAKENHI Grant Number JP21K17317.

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Authors and Affiliations

  1. Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Toshiki Maeda, Shintaro Ishida, Yori Inoue, Takako Fujii & Hisatomi Arima

  2. Division of Neurology, NHO Okinawa Hospital, Okinawa, Japan

    Yuichiro Ohya

  3. Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Yori Inoue

  4. Department of Neurology, Nippon Medical School, Tokyo, Japan

    Yuki Sakamoto

  5. Department of Cardiology, Kurume University Medical Center, Fukuoka, Japan

    Norihito Okina & Hisashi Kai

  6. Department of Health and Nutrition, Faculty of Health and Nutrition, Okinawa University, Naha, Japan

    Tetsutaro Niijima

  7. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan

    Kazunori Toyoda & Masatoshi Koga

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  1. Toshiki Maeda
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Correspondence to Toshiki Maeda.

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Maeda, T., Ohya, Y., Ishida, S. et al. Optimal blood pressure target for patients with prior stroke: A systematic review and meta-analysis. Hypertens Res 48, 1859–1869 (2025). https://doi.org/10.1038/s41440-025-02183-2

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