N Engl J Med
Triple low-dose pill cuts recurrent stroke risk after intracerebral hemorrhage
Clinical takeaway: A low-dose triple-pill strategy may offer a simpler, more effective way to lower blood pressure after intracerebral hemorrhage.
Lowering blood pressure is the only proven way to reduce recurrent stroke after intracerebral hemorrhage, but sustained control is often difficult in routine care. This trial tested whether a single pill combining three low-dose antihypertensive agents (telmisartan, amlodipine, and indapamide) could improve control and reduce recurrent events when added to standard care.
Researchers conducted a multinational, double-blind, randomized, placebo-controlled trial in 1,670 clinically stable patients with prior intracerebral hemorrhage and baseline systolic blood pressure of 130 to 160 mm Hg. After a 2-week active run-in, patients were randomly assigned to continue the triple pill or switch to placebo, both on top of standard care.
Recurrent stroke occurred in 4.6% of patients assigned to the triple pill and 7.4% of those assigned to placebo at a median follow-up of 2.5 years, a 39% lower risk. Major cardiovascular events were also less frequent with the triple pill, at 6.6% vs. 9.8%, a 33% lower risk.
Blood pressure control was better with the triple pill, with mean systolic pressure of 127 mm Hg during follow-up vs. 138 mm Hg with placebo. Serious adverse events were similar overall, but early discontinuation because of an adverse event was more common with the triple pill, most often due to a rise in serum creatinine.
“Lowering blood pressure is the only proven method to prevent another stroke, yet achieving good blood pressure control is a real challenge. One big issue is that the number and doses of antihypertensive medications are not increased when needed and doctors and patients struggle with complex pill regimens,” said Craig Anderson, MD, principal investigator and senior professorial fellow at The George Institute for Global Health.
“These findings could translate to important treatment benefits for the millions of people affected by intracerebral hemorrhage worldwide who face a high risk of having another stroke,” he concluded.
This combination was approved in June 2025 by FDA as brand name Widaplik to treat hypertension in adults, including as an initial treatment.
Source: Anderson CS. N Engl J Med. 2026 Apr 23. Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage