Secondary prevention refers to the treatment of individuals who have already had a stroke or Transient Ischemic Attack (TIA). Measures may include the use of platelet anti-aggregants, anti-hypertensives, statins, and lifestyle interventions. Hypertension is the major risk factor for ischaemic and haemorrhagic clinical strokes as well as for silent brain infarcts with a continuous association between both systolic and diastolic blood pressures. Hypertension is a major risk factor for stroke and Transient Ischemic Attack (TIA). The risk can be reduced by persistent correction of the hypertension.  Epidemiological data highlight the increasing burden to come over the next decades. Without any doubt, antihypertensive treatment is the most important therapy to reduce the risk of stroke by approximately 30-40%. International guidelines recommend antihypertensive treatment for primary prevention with evidence level A. Recurrent strokes or Transient Ischaemic Attack (TIA) are an important practical, clinical and economic problem, and have a major impact on the development of vascular dementia. All stroke patients and patients with TIA have to be regarded as very high-risk patients. Hypertension increases the risk of recurrent strokes. Only limited data directly address the role of blood pressure treatment among individuals with stroke or TIA. There is a general lack of definitive data regarding when to start antihypertensive treatment in the initial phase, and treatment of hypertension in the acute period after stroke is still under debate. Experimental and clinical data suggest that reducing the activity of the renin-angiotensin aldosterone system may have beneficial effects beyond the lowering of blood pressure. There is increasing evidence of cerebro-protective effects for medication influencing the RAAS, such as angiotensin receptor antagonists or ACE inhibitors. The MOSES study showed for the first time superiority of an angiotensin receptor antagonist compared with a calcium channel antagonist in antihypertensive treatment for secondary stroke prevention. Optimal blood pressure range in secondary prevention seems to be 120-140/80-90 mm Hg, but questions about a J- or U-shaped curve are still not answered sufficiently. The effects of additional antihypertensive treatment in the evening for stroke patients with 'non-dipping' blood pressure need to be investigated. Currently, the most important goal in primary and secondary prevention of stroke is a strict normotensive blood pressure control. Antihypertensive treatment is recommended for both prevention of recurrent stroke and prevention of other vascular events in individuals who have had an ischaemic stroke or TIA (class I, level of evidence A). Approximately 30% of ischemic strokes occur after a previous stroke or transient ischemic attack. Arterial hypertension is one of the best established risk factors for first and recurrent stroke, both ischemic and haemorrhagic. Guidelines for the secondary prevention of ischemic stroke support the use of Blood Pressure (BP) lowering drugs in most patients. However, the evidence for these recommendations comes from meta-analyses that included both ischemic and haemorrhagic stroke patients, whereas these 2 conditions differ quantitatively in several aspects. The use of BP-lowering drugs in patients with ischemic stroke or transient ischemic attack is associated with a 1.9% risk reduction of stroke but does not affect the all-cause mortality risk. In daily clinical practice in secondary stroke prevention it is recommended to keep BP below 130 mm Hg SBP and 85 mm Hg DBP, preferably with an ACEI and/or diuretic.

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