LOWER IS BETTER. FOR STROKES, LOWER BP MEANS LESS STROKE

I have always been an advocate of the lower the BP the better for patient, as long as the BP is not so low as to cause dizzy spells or troublesome lethargy. My rationale has always been that when the BP is lower, there is less tension on arterioles and capillaries, and so less likelihood of cerebral hemorrhage and also plaque rupture. A BP that is too low for that individual will be signaled by troublesome dizziness and lethargy.
To this end, Dr Oscar Benavente and colleagues at the University of British Columbia, Vancouver, presented the findings of SPS3 " secondary Prevention of small cortical strokes " at the International Conference of Strokes 2013, recently held at Honolulu. The SPS 3 is a study of 3,020 patients who had suffered a small cortical infarct, who were hypertensive and who and were on followup. They were divided into 2 groups with similar baseline BP and baseline characteristics. One group was placed on anti-hypertensive therapy and whose BP was controlled to 130-149mmHg systolic ( Gp 1 ) and the other group had their BP reduced to less than 130 mmHg systolic ( Gp 2 ). At baseline, Gp 1 had 1.8 number of medications compared to Gp 2 who had 1.7. After 3.7 yrs of follow-up, Gp 1 had 1.8 medications and Gp 2 had 2.4. The patients in Gp 1 had 152 incidence of re-stroke and Gp 2 had 125 cases of re-stroke. The p value was 0.08 ( not quite statistically significant, but almost ). Dr Oscar and coleagues reported that the trend was strong and that reducing BO to < 130 mmHg systolic is better.
Obviously I agree. If there is no downside,
In this study by Dr Oscar Benavente, the lower systolic BP did translate to a trend of lesser number of strokes.