BACKGROUND AND OBJECTIVES: It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke. RESULTS: A review of existing data from randomized controlled trials confirms that solid evidence on optimal BP and LDL-C targets is missing, possible interactions between BP and LDL-C lowering treatments have never been directly investigated, and evidence in favour of a beneficial effect of BP or LDL-C lowering on cognitive decline is, at best, very weak. CONCLUSION: A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.

Istituto Auxologico Italiano bUniversità di Milano Milan Italy cFuWai Hospital and Cardiovascular Institute dBeijing Hypertension League Institute Beijing China eUniversità Milano Bicocca fIRCCS Multimedica Sesto San Giovanni Milan Italy gOslo University Hospital Oslo Norway hUniversity of Valencia Madrid Spain iMedical University of Gdansk Gdansk Poland jUniversity of Glasgow Glasgow UK kLund University Scania University Hospital Malmo Sweden lTallinn University of Technology Tallinn Estonia mEuropean Hospital Georges Pompidou Paris France nUniversità di Brescia Spedali Civili Brescia Italy oBeijing Anzhen Hospital Beijing pShanghai Hypertension Institute Shanghai China qComplutense University rHospital 12 de Octubre sHospital Clínico San Carlos Madrid Spain tCentro Hospitalar de Entre o Douro e Vouga E P E Portugal uNephrology and Hypertension University Hospital Erlangen Germany vUniversity Hospital of Lausanne Lausanne Switzerland wMedical University of Lodz Lodz Poland xCharles University Medical School 1 and Thomayer Hospital Prague Czech Republic ySt Imre University Teaching Hospital Budapest Hungary zAlmazov Federal Heart Blood and Endocrinology Center St Petersburg Russia aaRSPC Cardiology Minsk Belarus abNSC 'Institute of Cardiology named after N D Strazhesko' of NAMS Kiev Ukraine acEmergency Hospital of Bucharest Bucharest Romania adUniversity Hospital Saint Anna Sofia Bulgaria aeDr Peter Drzai Hospital Ljubljana Slovenia afUniversity Hospital Center Zagreb Zagreb Croatia agClinic for Internal Medicine InterMedic Nis Serbia ahCardiology Department Asklepeion General Hospital Athens Greece aiNicosia General Hospital Nicosia Cyprus ajIstanbul University Cerrahpaşa School of Medicine Istanbul Turkey akHasharon Hospital Rabin Medical Center Petach Tikva Israel alBeijing Xuanwu Hospital am 2nd Affiliate Hospital Beijing University anMilitary General Hospital Beijing China aoH

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