• Jonathan Mant, Richard J McManus, Andrea Roalfe, Kate Fletcher, Clare J Taylor, Una Martin, Satnam Virdee, Sheila Greenfield, and F D Richard Hobbs.
• Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK jm677@medschl.cam.ac.uk.
• BMJ. 2016 Jan 1; 352: i708.

ObjectiveTo assess whether using intensive blood pressure targets leads to lower blood pressure in a community population of people with prevalent cerebrovascular disease.DesignOpen label randomised controlled trial.Setting99 general practices in England, with participants recruited in 2009-11.ParticipantsPeople with a history of stroke or transient ischaemic attack whose systolic blood pressure was 125 mm Hg or above.InterventionsIntensive systolic blood pressure target (<130 mm Hg or 10 mm Hg reduction from baseline if this was <140 mm Hg) or standard target (<140 mm Hg). Apart from the different target, patients in both arms were actively managed in the same way with regular reviews by the primary care team.Main Outcome MeasureChange in systolic blood pressure between baseline and 12 months.Results529 patients (mean age 72) were enrolled, 266 to the intensive target arm and 263 to the standard target arm, of whom 379 were included in the primary analysis (182 (68%) intensive arm; 197 (75%) standard arm). 84 patients withdrew from the study during the follow-up period (52 intensive arm; 32 standard arm). Mean systolic blood pressure dropped by 16.1 mm Hg to 127.4 mm Hg in the intensive target arm and by 12.8 mm Hg to 129.4 mm Hg in the standard arm (difference between groups 2.9 (95% confidence interval 0.2 to 5.7) mm Hg; P=0.03).ConclusionsAiming for target below 130 mm Hg rather than 140 mm Hg for systolic blood pressure in people with cerebrovascular disease in primary care led to a small additional reduction in blood pressure. Active management of systolic blood pressure in this population using a <140 mm Hg target led to a clinically important reduction in blood pressure.Trial registration Current Controlled Trials ISRCTN29062286.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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