37 The Secondary Prevention of Small Subcortical Strokes (SPS3) trial, aside from studying the effect of dual-antiplatelet therapy, also examined the role of strict vs standard blood pressure management (systolic, <130 mmHg vs 130–149 mmHg) on the outcome of stroke recurrence and showed a trend toward benefit in stroke recurrence in the lower blood pressure group. 38 Current American Heart Association guidelines recommend blood pressure goals of, <140 mmHg and diastolic, 90 mmHg; however, there is evidence that the benefit of lowering blood pressure extends to levels far below this cutoff, and as suggested in the PROGRESS trial, treatment should not be reserved for only those with history of hypertension. 6 , 39 Hyperlipidemia Hypercholesterolemia is another general target in secondary stroke prevention.
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