Stroke and transient ischemic attack (TIA) survivors who received intensive blood pressure treatment targeting systolic pressure below 120 mm Hg had a significantly lower risk of death or major cardiovascular events within four years compared to those who received standard treatment targeting below 140 mm Hg, according to late-breaking science presented at the American Heart Association’s Scientific Sessions 2026. The trial, conducted in Brazil, also published simultaneously in the New England Journal of Medicine.
The study, called the OPTIMAL-Stroke Trial, enrolled 4,368 adults with a prior ischemic stroke or transient ischemic attack (TIA) and elevated blood pressure between 130 and 180 mm Hg. Participants were randomized to intensive treatment (target systolic <120 mm Hg) or standard treatment (target systolic <140 mm Hg) across 30 health centers. Over an average follow-up of 3.9 years, the intensive group experienced a 21% reduction in major cardiovascular events—10.9% versus 13.5% in the standard group. Recurrent strokes occurred in 4.7% of the intensive group versus 6.4% in the standard group, driven by fewer ischemic strokes.
“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 Otavio Berwanger, M.D., Ph.D., chair of the OPTIMAL study Steering Committee and executive director at The George Institute for Global Health. The findings underscore that high blood pressure is the single most important modifiable risk factor for stroke. The American Heart Association/American College of Cardiology 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 encourages targets below 120 mm Hg for people at increased cardiovascular risk.
Serious adverse events were similar between groups, but kidney-related events increased in the intensive group, highlighting the need for individualized treatment and careful monitoring of kidney function. “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,” said principal investigator Gisele Sampaio, M.D., Ph.D., professor of neurology at the Federal University of São Paulo. The trial’s limitation includes that not all intensive-group patients reached the <120 mm Hg target, and results may not be generalizable outside Brazil.
For readers, this research reinforces the importance of knowing your blood pressure and discussing individual targets with healthcare providers. The American Stroke Association offers resources on Preventing Another Stroke, and the American Heart Association provides guidance on Understanding Blood Pressure Readings. The full study was presented at Scientific Sessions 2026, a premier global exchange of cardiovascular science. The abstract is available in the 2026 Online Program Planner. The American Heart Association maintains transparency; its financial information is available here.
