Recurrent stroke is a major public health concern, occurring in approximately one third of stroke survivors within 5 years. Besides, the overall aging of the developed countries population and the improved survival of patients with stroke have created a large population of older adults in need of secondary stroke prevention. Thus, at present, more than 5% of individuals 65 to 74 years old and more than 10% of those 75 and older have had a prior stroke. An age bias exists in the prescription of important secondary-preventive therapies in the elderly. Knowledge of the evidence behind the secondary prevention strategies could be useful to practicing physicians caring for stroke elderly patients. Effective strategies for the secondary prevention of stroke include treatment of hypertension and hyperlipidaemia. Our review presents the most recent evidence on hypertension and lipid lowering therapy for stroke prevention in elderly patients with previous stroke or TIA. Basis for evidence (or the lack thereof), areas of controversy, and avenues of future focus for these treatments are also discussed in this paper.