Stroke is the third leading cause of morbidity and mortality worldwide and a major cause of physical and intellectual disability, hence the need for clinically implementable strategies that lower stroke incidence and recurrence effectively and safely. Several studies have shown that stroke recurrence is closely and directly related to raised and even high-normal blood pressure, suggesting that blood pressure–lowering agents could exert a protective effect. This paper focuses on primary stroke prevention by examining the causes, risk factors, and current therapeutic approaches. It also reviews knowledge on secondary prevention and examines the potential of blood pressure– lowering drugs in this regard, with particular respect to a major recent intervention trial—Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS)—whose results demonstrate for the first time that angiotensin-converting enzyme inhibitor treatment markedly reduces stroke recurrence and prevents subsequent cognitive deterioration...