Results of a recent Cochrane review support the use of blood pressure-lowering drugs (BPLDs) for reducing the risk of recurrent stroke in people with stroke or transient ischemic attack (TIA). The current evidence is primarily derived from trials studying an angiotensin-converting enzyme (ACE) inhibitor or a diuretic. Researchers included 11 studies involving a total of 38,742 participants: 8 studies compared BPLDs vs placebo or no treatment (35,110 participants), and 3 studies compared different systolic blood pressure targets (3,632 participants). They found:

• The risk of bias varied greatly between included studies.
• The pooled risk ratios (RRs) of BPLDs were 0.81 (8 randomized controlled trials [RCTs]; 35,110 participants; moderate-quality evidence), 0.90 (4 RCTs; 28,630 participants; high-quality evidence) for major vascular event, and 0.88 (2 RCTs; 6,671 participants; high-quality evidence) for dementia.
• There was a reduced risk of recurrent stroke in the subgroup of participants using an ACE inhibitor or a diuretic (I² statistic for subgroup differences 72.1%).