# OPTIMAL-Stroke: systolic target below 120 mmHg cut major cardiovascular events from 13.5% to 10.9%

- Published: 2026-11-07 20:27 UTC
- Section: Life & Health › Medicine
- Tags: OPTIMAL-Stroke, systolic blood pressure below 120 mmHg, intensive blood pressure lowering, stroke recurrence, transient ischemic attack, MACE, SPRINT trial, renal events, American Heart Association 2026
- URL: https://realtech.media/news/rt-d2659dfea1df6132faebd5c9_optimal_stroke_systolic/

**In the OPTIMAL-Stroke trial of 4,368 patients after stroke or TIA in Brazil, a systolic target below 120 mmHg gave fewer events than below 140 mmHg, with more renal events.**

![OPTIMAL-Stroke: systolic target below 120 mmHg cut major cardiovascular events from 13.5% to 10.9%](https://realtech.media/media/2026/11/3ddb06e96f824e1d.webp)
*ad-hoc-news.de*

The clinical trial OPTIMAL-Stroke was presented at the American Heart Association Scientific Sessions in Chicago in November 2026 and published simultaneously in the New England Journal of Medicine, according to ad-hoc-news.de. [1] The study compared strict lowering of systolic blood pressure to below 120 mmHg with the standard target of below 140 mmHg in people who had survived an ischemic stroke or a transient ischemic attack (TIA). [1]

## Participants and design

Between 2019 and 2022, a total of 4,368 patients were recruited at 30 centers in Brazil. The mean age was 64 years, and women made up 47.9% of the cohort. [1] Inclusion required a previous ischemic stroke or TIA and a baseline systolic pressure between 130 and 180 mmHg. The mean baseline pressure of participants was 146.7/81.6 mmHg. [1]

The report notes that the study matters for future guideline work, because stroke survivors were excluded from earlier landmark trials such as SPRINT. A parallel study, OPTIMAL-Diabetes, tested the same systolic target of below 120 mmHg at the same baseline range of 130 to 180 mmHg. Both projects were designed to close evidence gaps left by SPRINT for specific high-risk groups. [1]

## Results and limitations

Over a mean follow-up of 3.9 years, the primary combined endpoint of major cardiovascular events (MACE) occurred in 10.9% of participants in the intensive group (target below 120 mmHg) and in 13.5% in the standard group (target below 140 mmHg). This corresponds to a relative reduction of about 21%. [1]

The risk of recurrent cerebrovascular events also fell. A stroke recurrence occurred in 6.4% of the control group and in 4.7% of the intensively treated group. [1]

The analysis also points to adverse effects. Renal events were recorded more often under intensified blood pressure therapy, which underlines the need for continuous monitoring of kidney function when medication is adjusted more aggressively. [1]

The report names methodological limitations. Not all participants in the intensive arm kept their systolic pressure below 120 mmHg throughout the study. The cohort was also restricted to 30 sites in Brazil, so applicability to other health systems and populations requires further confirmation. [1]

## Sources

1. [ad-hoc-news.de](https://www.ad-hoc-news.de/wissenschaft/optimal-stroke-strenge-blutdrucksenkung-senkt-herzrisiken-um-21-prozent/70475670)

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Source: RealTech, realtech.media — https://realtech.media/news/rt-d2659dfea1df6132faebd5c9_optimal_stroke_systolic/