We assessed, in a double-blind, placebo-controlled trial, whether lowering blood pressure (BP) prevents the recurrence of
stroke in Chinese patients with
cerebrovascular disease. Patients were randomized into two groups: 2825 patients received a placebo and 2840 patients received 2.5 mg of
indapamide daily. The primary and secondary outcomes were the recurrence of fatal or nonfatal
stroke and major fatal and nonfatal cardiovascular events, respectively. The average systolic/diastolic BP at randomization was 153.8/92.8 mm Hg. At median follow-up (2 years), BP was, on an average, 6.8/3.3 mm Hg lower in patients on active treatment. In total, 143 patients on
indapamide and 219 patients on placebo had recurrent
strokes (hazard ratio for
indapamide, 0.69; 95% confidence interval (CI): 0.54-0.89; P<0.001). In addition, 199 patients on
indapamide and 258 patients on placebo had a cardiovascular event (hazard ratio, 0.75; 95% CI: 0.89-0.62; P=0.002). We performed a systematic review of literature that included our new results. Across 10 trials, the odds ratio for the prevention of
stroke recurrence by BP lowering was 0.78 (95% CI: 0.68-0.90; P=0.0007). The pooled odds ratio was 0.63 (95% CI: 0.54-0.73; P<0.0001) for trials involving
diuretics as a component of
therapy and 0.93 (95% CI: 0.87-1.01; P=0.086) for trials in which treatment included
renin system inhibitors (P<0.0001 for heterogeneity). The weighted correlation between the odds for
stroke recurrence and the reduction in systolic BP was -0.57 (P=0.067). In conclusion, BP lowering by
indapamide treatment reduced the recurrence of
stroke and the incidence of cardiovascular events in Chinese patients with
cerebrovascular disease. Whether prevention of
stroke recurrence depends on
drug class, degree of BP lowering or both requires further investigation.