Patients who have survived an ischemic stroke or transient ischemic attack (TIA) can reduce their risk of major cardiovascular events by aiming for a lower systolic blood pressure target, according to results from the OPTIMAL-STROKE trial presented at the American Heart Association Scientific Sessions in Chicago.
The study, which involved 4,368 participants in Brazil, found that targeting a systolic blood pressure of less than 120 mm Hg was more effective at preventing death, heart attack, and recurrent stroke than the standard treatment goal of less than 140 mm Hg. The findings were published in the New England Journal of Medicine on November 7, 2026.
Lowering systolic blood pressure reduces major cardiovascular risks
Researchers tracked participants for a median of 3.9 years to compare the safety and efficacy of different blood pressure targets. Those in the intensive treatment group experienced major cardiovascular events at a rate of 10.9%, while 13.5% of those receiving standard care experienced such events, HCPLive reported.
The reduction in risk was specifically driven by a lower incidence of ischemic strokes. In the intensive group, the rate of recurrent stroke was 4.7%, compared to 6.4% in the standard group, according to American Heart Association data.
| Outcome Category | Intensive Group (< 120 mm Hg) | Standard Group (< 140 mm Hg) |
|---|---|---|
| Major Cardiovascular Events | 10.9% (236 participants) | 13.5% (297 participants) |
| Recurrent Stroke | 4.7% | 6.4% |
| Serious Adverse Events | 15.1% | 15.3% |
Intensive targets raise concerns regarding kidney function
While the intensive treatment lowered cardiovascular risks, it was associated with a higher frequency of certain side effects. The composite renal outcome occurred in 3.9% of the intensive group versus 2.2% in the standard group, HCPLive reported.
Serum sodium levels below 130 mmol/L were noted in 3.3% of the intensive group compared to 2.2% of the standard group. Gisele Sampaio of the Federal University of Sao Paulo said that a lower blood pressure target may offer greater protection, but we must ensure that the right target is achieved safely and tailored to each patient.
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,
Gisele Sampaio, principal investigator, Federal University of São Paulo and Albert Einstein Hospital
Mixed results for blood pressure targets in diabetes patients
A related study, the OPTIMAL-DIABETES trial, reached different conclusions regarding intensive targets for a different patient population. Research involving patients with type 2 diabetes found that the ideal blood pressure target in these patients is still uncertain, according to STAT.
🧠 OPTIMAL-Stroke: 4,368 prior ischemic stroke/TIA; 47.9% women, followed for 3.9y 🫀lower 🆚 higher BP: SBP <120 vs <140: MACE 10.9% vs 13.5%; HR 0.79 (95% CI 0.67–0.94) 💥Supports lower target BPhttps://t.co/w7gGY7FIrD#AHA26 #ScientificSessions26 #CVPrev @NEJM pic.twitter.com/KBrVPlHYI3
— https://x.com/DrMarthaGulati/status/2119215447098667437
Challenges in coordinating post-stroke care
Bruce Ovbiagele of the UCSF Weill Institute for Neurosciences noted that approximately one out of five stroke survivors discontinue their antihypertensive medications within one year of their stroke.
It’s not the what, but it’s the how,
Cheryl Bushnell, Wake Forest University
Frequently Asked Questions about the OPTIMAL-STROKE findings
Who participated in the OPTIMAL-STROKE trial?
The trial enrolled 4,368 men and women at 30 health centers in Brazil. Participants had a history of ischemic stroke or transient ischemic attack (TIA) and had systolic blood pressure between 130 and 180 mm Hg at the time of enrollment.
What were the specific risks of the intensive blood pressure target?
While serious adverse events were similar between groups, the intensive group saw higher rates of kidney-related outcomes and hyponatremia (low sodium). Specifically, the composite renal outcome was 3.9% in the intensive group compared to 2.2% in the standard group.