Triple Low-Dose BP-Lowering Pill Reduces Recurrent Stroke After Intracerebral Hemorrhage

In patients with prior intracerebral hemorrhage, adding a single pill combining three low-dose antihypertensive agents to standard care significantly reduced recurrent stroke and major cardiovascular events compared with placebo. In this multinational, double-blind, randomized controlled trial of 1,670 clinically stable patients with baseline systolic blood pressure (BP) of 130–160 mm Hg, participants first completed a 2-week run-in phase on a triple pill (telmisartan 20 mg, amlodipine 2.5 mg, and indapamide 1.25 mg) and were then randomized to continue the regimen or switch to placebo. Over a median follow-up of 2.5 years, recurrent stroke occurred in 4.6% of the triple-pill group versus 7.4% of the placebo group, representing a 39% relative risk reduction, alongside lower mean systolic BP (127 mm Hg vs 138 mm Hg). Major cardiovascular events were also reduced (6.6% vs 9.8%). While overall serious adverse events were similar between groups, treatment discontinuation due to adverse events—most commonly increased serum creatinine—was more frequent in the triple-pill group. These findings support the effectiveness of fixed low-dose combination therapy as an intensified BP–lowering strategy to prevent recurrent stroke after intracerebral hemorrhage. Source: https://www.nejm.org/