<br>        Inclusion Criteria:<br><br>        Patients may be enrolled in the trial if all of the following criteria have been met:<br><br>          -  Symptomatic SVD defined as<br><br>               -  History of clinical lacunar stroke in the last 5 years with a corresponding small<br>                  subcortical infarct visible on MRI scan or CT scan* compatible with the clinical<br>                  syndrome.<br><br>                  *On MRI, recent infarct is defined as a diffusion-weighted imaging (DWI) lesion<br>                  on the acute MRI scan. On CT, recent infarct is defined as a novel infarct on CT<br>                  within 3 weeks after the event that was not visible on the admission CT. Patients<br>                  admitted to the hospital with an obvious lacunar syndrome and an admission CT/CT<br>                  perfusion compatible with a lacunar infarct but without an MRI in the (sub)acute<br>                  stage and no repeat CT performed in the context of clinical care can be recruited<br>                  for TREAT-SVDs. After providing informed consent they will be invited for the<br>                  screening visit including a 3T MRI. The 3T MRI will be used to verify the<br>                  presence of a new lesion, relative to the admission CT, compatible with a lacunar<br>                  infarct and compatible with the lacunar syndrome. If such a lesion is present the<br>                  patient will undergo the further TREAT-SVDs workup. If no such lesion is observed<br>                  the patient will be excluded from the study and considered as a screening<br>                  failure.<br><br>               -  or cognitive impairment defined as visiting a memory clinic with cognitive<br>                  complaints, objective cognitive impairment*, and capacity to consent, and with<br>                  confluent deep white matter hyperintensities (WMH) on MRI (defined on the Fazekas<br>                  scale as deep WMH score = 2)<br><br>                  *concluded by the treating physician based on a validated cognitive measurement<br>                  tool (for example but not limited to MoCA or CAMCOG)<br><br>               -  or a diagnosis of CADASIL established by molecular genetic testing of the NOTCH3<br>                  gene (presence of an archetypical, cysteine-affecting mutation) or the presence<br>                  of granular osmiophilic material in ultrastructural, electron microscopy analysis<br>                  of skin biopsy<br><br>          -  Indication for antihypertensive treatment (as defined by meeting one of the<br>             following):<br><br>               -  Hypertension defined as SBP = 140 mmHg or diastolic BP (DBP) = 90 mmHg without<br>                  antihypertensive treatment or use of an antihypertensive drug for previously<br>                  diagnosed hypertension<br><br>               -  Prior history of stroke or transient ischaemic attack (TIA)<br><br>          -  Age 18 years or older<br><br>          -  Written informed consent<br><br>        Exclusion Criteria:<br><br>        Patients will be excluded from the trial for any of the following reasons:<br><br>          -  Inclusion criteria are not met<br><br>          -  Unwillingness or inability to give written consent<br><br>          -  Pregnant or breastfeeding women, women of childbearing age not taking contraception.<br><br>        Acceptable contraception in women of childbearing age is a highly effective contraceptive<br>        measure as defined by the Clinical Trials Facilitation Group and includes combined<br>        (oestrogen and progesterone containing) or progesterone-only contraception associated with<br>        inhibition of ovulation, or intrauterine device, or bilateral tubal occlusion.<br><br>          -  Contraindications to MRI (pacemaker, aneurysm clip, cochlear implant etc.)<br><br>          -  Other major neurological or psychiatric conditions affecting the brain and interfering<br>             with the trial design (e.g. multiple sclerosis)<br><br>          -  In case of clinical lacunar stroke syndrome other causes of stroke such as<br><br>               -  = 50% luminal stenosis (NASCET) in large arteries supplying the area of ischaemia<br><br>               -  major-risk cardioembolic source of embolism (permanent or paroxysmal atrial<br>                  fibrillation, sustained atrial flutter, intracardiac thrombus, prosthetic cardiac<br>                  valve, atrial myxoma or other cardiac tumours, mitral stenosis, recent (< 4<br>                  weeks) myocardial infarction, left ventricular ejection fraction less than 30%,<br>                  valvular vegetations, or infective endocarditis)<br><br>               -  other specific causes of stroke identified (e.g. arteritis, dissection,<br>                  migraine/vasospasm, drug misuse)<br><br>          -  Other stroke risk factor requiring immediate intervention that would preclude<br>             involvement in the trial<br><br>          -  Renal impairment (eGFR < 35ml/min)<br><br>          -  Life expectancy < 2 years<br><br>          -  Use of > 2 antihypertensive drugs at maximum dose or equivalent (one drug at the<br>             maximum dose and two drugs at half of the maximum dose) for an appropriate BP control<br><br>          -  Contraindications to the applied antihypertensive drugs as known<br><br>               -  Severe aortic stenosis<br><br>               -  Bilateral renal artery stenosis<br><br>               -  Severe arterial circulatory disorders<br><br>               -  Atrioventricular block II° or III° or sick sinus syndrome<br><br>               -  Heart failure (NYHA III or IV)<br><br>               -  Bradycardia, resting heart rate < 50/min<br><br>               -  Bronchospastic diseases such as severe bronchial asthma<br><br>               -  Severe hepatic dysfunction such as liver cirrhosis<br><br>               -  Use of monoamine oxidase (MAO)-A-blockers<br><br>               -  Use of simvastatin > 20mg/d<br><br>               -  Metabolic acidosis<br><br>               -  Disturbed electrolyte homeostasis such as hypercalcaemia, hypokalaemia, and<br>                  hyponatraemia<br><br>               -  Symptomatic hyperuricaemia (gout)<br>