Recurrent Stroke Prevention Clinical Outcome Study

1. Objectives and Hypothesis 1. Objectives: This study evaluates whether strict BP management is useful for the prevention of recurrent stroke. Hypertensive patients with history of stroke are treated with stepwise multi-drug therapy to achieve stricter BP target \<120/80 mmHg in the strict BP control group and less stricter BP target \<140/90 mmHg or \<130/80 mmHg for patients with current DM/CKD/MI in the standard BP control group. The participants under the BP treatment achieving their respective BP target will be followed for recurrence of stroke. The study continues until the number of patients with the first recurrent stroke reaches a total of 330 between the two groups. The occurrence rates of recurrent stroke will be compared between the two groups. 2. Hypotheses The incidence of recurrent stroke will be lower in a strict BP control group having lower BP target: \<120/80 mmHg\* than in a standard BP control group having BP target \<140/90 mmHg or \<130/80 mmHg for current DM/CKD/MI in patients with hypertension. 2. Study design This will be a multicenter, randomized, open-label study. The study consists of a screening period, a titration period and a follow-up period. The screening period is a period between the date of consent and the enrollment date. Hypertensive patients with history of stroke are randomly assigned to either the strict BP control group having the target of \<120/80 mmHg or the standard BP control group having the target of \<140/90 mmHg without current DM, CKD or MI and \<130/80 mmHg with current DM, CKD or MI. The titration period is the period finding a treatment which achieves target BP, and 24 weeks at maximum. Patients will be treated with stepwise multi-drug therapy using an angiotensin-receptor antagonist, diuretic, calcium channel blocker and aldosterone antagonist. The participants will be observed under the BP management for their respective BP target. The study will be continued until the number of patients