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Ney Carter Borges: Simplifying Blood Pressure Control After Intracerebral Hemorrhage
Ney Carter Borges/LinkedIn
Jul 1, 2026, 12:14

Ney Carter Borges: Simplifying Blood Pressure Control After Intracerebral Hemorrhage

Ney Carter Borges, Member Cardiologist of Global Physician Association at Cleveland Clinic Florida, shared a post on LinkedIn about a recent article by Craig S Anderson et al., published in NEJM, adding:

“Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage

Survivors of spontaneous intracerebral hemorrhage (ICH) remain at exceptionally high risk of recurrent stroke, with long-term blood pressure control representing the only proven preventive strategy. However, therapeutic inertia, poor adherence, and treatment complexity frequently prevent patients from reaching recommended blood pressure targets.

The multinational TRIDENT trial evaluated whether a fixed-dose, low-dose triple antihypertensive pill (telmisartan 20 mg, amlodipine 2.5 mg, and indapamide 1.25 mg), added to standard care, could improve secondary prevention after ICH.

In this double-blind, placebo-controlled study, 1,670 clinically stable patients with previous spontaneous ICH were randomized after a successful run-in phase and followed for a median of 2.5 years.

The triple-pill strategy achieved substantially better blood pressure control, maintaining a mean systolic blood pressure of 127 mmHg compared with 138 mmHg in the placebo group.

This translated into a 39% relative reduction in recurrent stroke (HR 0.61; 95% CI, 0.41–0.92), largely driven by a marked reduction in recurrent intracerebral hemorrhage (HR 0.40).

Major cardiovascular events were also significantly reduced (HR 0.67), while cardiovascular mortality remained similar between groups.

Approximately 35 patients needed to be treated to prevent one recurrent stroke, highlighting a clinically meaningful benefit.

Although treatment discontinuation was more frequent in the intervention group, primarily because of protocol-mandated increases in serum creatinine or symptomatic hypotension, serious adverse events were not increased, and no evidence suggested accelerated long-term kidney disease progression.

The TRIDENT trial provides compelling evidence that early implementation of a simplified fixed-dose combination can substantially improve blood pressure control and reduce recurrent cerebrovascular events after ICH.

Beyond demonstrating efficacy, this strategy addresses one of the greatest barriers in hypertension management-medication adherence-offering a practical, scalable approach that may reshape future secondary stroke prevention guidelines for this particularly vulnerable population.”

Title: Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage

Authors: Craig S Anderson, Clara K Chow, H Asita de Silva, Bimsara Senanayake, Kolawole Wahab, Rustam Al-Shahi Salman, Catharina J M Klijn, Sheila Ouriques Martins, Natalie Espinosa, Lauren Kuhles, Laurent Billot, Hisatomi Arima, Cheryl Carcel, Xia Wang, Qiang Li, Sana Shan, Mathangi Shanthakumar, Huy Thang Nguyen, Dilum Palliyaguruge, Janaka Peiris, Udaya K Ranawaka, Senaka Bandusena, Thambipillai Rajendiran, Darshana Wijegunasinghe, Harsha Gunasekera, Indunil Wijeweera, Athula Dissanayake, Ajantha Keshavaraj, Reginald O Obiako, Rufus Akinyemi, Luiz Nasi, Rodrigo Bazan, Carla Heloisa Cabral Moro, Mariana Battaglini, Viviane Zétola, Wan Chung Law, Yuen Kang Chia, Dennis Cordato, Rohan Grimley, Anuradha Dahanayaka, Sonali Liyanagamage, Nilukshi Fernando, Nihara Abdul Rasheed, Nodar Kakabadze, Maia Beridze, Mythily Aravinthan, Vithoosan Sahathevan, Devasmitha Wijesundara, Pramith Ruwanpathirana, Wan Asyraf Wan Zaidi, Tinatin Kherkheulidze, Urs Fischer, Ana Cláudia de Souza, Tsong-Hai Lee, Christopher Chen, Octavio Pontes-Neto, Thompson Robinson, Jiguang Wang, Sharon L Naismith, Michael Barnett, Carlos Delfino, Shoujiang You, Feifeng Liu, Candice Delcourt, Tom J Moullaali, Tim Wilkinson, Neil Watson, Karla Santo, Qiao Han, Mariana Almudi Souza, Wilmar M T Jolink, Anderson Berni Cristofari, Zien Zhou, Floris H Schreuder, Richard I Lindley, Manuela Armenis, Mark Woodward, Ruth Freed, Lili Song, John Chalmers, Anthony Rodgers

Ney Carter Borges: Simplifying Blood Pressure Control After Intracerebral Hemorrhage

Other posts featuring Ney Carter Borges on Hemostasis Today.

Ajantha Keshavaraj Ana Claudia de Souza Anderson Berni Cristofari Anthony Rodgers Anuradha Dahanayaka Athula Dissanayake Bimsara Senanayake Candice Delcourt Carla Heloisa Cabral Moro Carlos Delfino Catharina J.M. Klijn Cheryl Carcel Christopher Chen Clara K. Chow Craig S. Anderson Darshana Wijegunasinghe Dennis Cordato Devasmitha Wijesundara Dilum Palliyaguruge Feifeng Liu Floris H. Schreuder H. Asita de Silva Harsha Gunasekera Health Hematology Hemostasis Hemostasis News Hemostasis Today Hisatomi Arima Huy Thang Nguyen ICH Indunil Wijeweera intracerebral hemorrhage Janaka Peiris Jiguang Wang John Chalmers Karla Santo Kolawole Wahab Lauren Kuhles Laurent Billot Lili Song Luiz Nasi Maia Beridze Manuela Armenis Mariana Almudi Souza Mariana Battaglini Mark Woodward Mathangi Shanthakumar Medicine Michael Barnett Mythily Aravinthan Natalie Espinosa Neil Watson NEJM Ney Carter Borges Nihara Abdul Rasheed Nilukshi Fernando Nodar Kakabadze Octávio Pontes-Neto Pramith Ruwanpathirana Qiang Li Qiao Han Reginald O. Obiako Richard I Lindley Rodrigo Bazan Rohan Grimley Rufus Akinyemi Rustam Al-Shahi Salman Ruth Freed Sana Shan Senaka Bandusena Sharon L. Naismith Sheila Ouriques Martins Shoujiang You Sonali Liyanagamage Thambipillai Rajendiran Thompson Robinson Tim Wilkinson Tinatin Kherkheulidze Tom J. Moullaali Tsong-Hai Lee Udaya K. Ranawaka Urs Fischer Vithoosan Sahathevan Viviane Zétola Wan Asyraf Wan Zaidi Wan Chung Law Wilmar M.T. Jolink Xia Wang Yuen Kang Chia Zien Zhou
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