A Phase III randomized controlled trial in New Zealand is testing whether Health and Wellness coaching can reduce systolic blood pressure by 6 mmHg in stroke survivors, targeting the 90% of strokes deemed preventable through lifestyle modification. The study enrolled 360 adults with recent minor strokes or transient ischemic attacks who have multiple cardiovascular risk factors and elevated blood pressure, comparing personalized coaching against usual care over six months. This represents a significant step toward addressing stroke recurrence through behavioral intervention rather than solely pharmaceutical approaches. The 6 mmHg target reduction, while modest, could translate to meaningful population-level stroke prevention given that even small blood pressure reductions correlate with substantial cardiovascular risk reduction. However, the open-label design introduces potential bias, and the study focuses on relatively healthy stroke survivors who remain independent in daily activities. The coaching approach addresses multiple risk factors simultaneously, which may prove more effective than single-intervention strategies. As this is a preprint awaiting peer review, the methodology and eventual results require validation. If successful, this could establish health coaching as a standard component of secondary stroke prevention programs globally.