BACKGROUND: Direct correlation between stroke mortality and hypertension calls for a tight blood pressure (BP) control. Our study determined the prevalence of the BP control and evaluated current clinical practices on hypertension management in stroke patients in Thailand. METHODS: This multicenter, cross-sectional, retrospective, observational study was carried out between February 2010 and January 2011 and enrolled stroke patients aged 45 years or older with ictus incidence 12,030 days before the enrollment. The events were confirmed by either computerized tomography scan or magnetic resonance imaging. Patient data including demographics, medical, and clinical history were collected. RESULTS: At enrollment, 274 of 558 (49.1%) patients had controlled arterial BP with an average pressure of 134.220.4/78.812.8 mm Hg; 412 (73.8%) patients received antihypertensive medications and the most common use was angiotensin-converting enzyme inhibitors (ACEIs), reported in 200 (35.8%) patients. With questionnaire, insufficient antihypertensive use and lack of patients' awareness were the 2 most common reasons given by physicians for the patients' uncontrolled BP. Factors identified to have adverse association with the controlled BP at enrollment were diabetes at baseline, stage II hypertension, stage I hypertension, and the use of ACEIs at discharge (odds ratio of .18, .24, .30 [P < .001], and .53 [P = .009], respectively). CONCLUSIONS: Despite clinical evidence of the benefits of the BP control in reduction of secondary stroke events, a substantial number of stroke patients in Thailand do not achieve their BP targets, and this could possibly be a result of inadequate use of antihypertensive therapies and lack of compliance to BP management guidelines.