Abstract Body: Background: Despite the evidence suggesting the use of antihypertensives in patients with ischemic stroke (IS), the heterogeneity of the clinical trials included in guidelines compromises the recommendation of a blood pressure (BP) target and the intensity of the BP reduction required. Objective-The primary objective of the OPTIMAL-Stroke trial is to determine if a more intensive BP control target compared to the standard BP target in a population of patients with previous IS has an impact on the reduction of major cardiovascular events. Methods: OPTIMAL-Stroke is a randomized, controlled, 1:1 open-label clinical trial with blind assessment of clinical outcomes. Population-Patients were eligible to the study if they are over 18 years and have a history of IS or transient ischemic attack, clinically stable for at least 48 hours prior to study inclusion and have a systolic blood pressure of 130-180 mmHg. Sample Size-4060 patients. Results: Intervention: Patients were randomized to either an intensive BP control group targeting SBP <120 mmHg or to a control group, targeting SBP <140 mmHg. Outcome-The primary outcome is the first occurrence of a composite outcome of major cardiovascular events (cardiovascular death, non-fatal myocardial infarction (MI), non-fatal stroke, hospitalization for unstable angina or hospitalization for heart failure). Statistical Analysis-The analysis of primary efficacy outcome will be the comparison between the two groups using a long-rank test procedure. Trial Status-Enrollment is finished at 30 sites. A total of 4368 patients were randomized and are currently being followed.