TRIDENT
(2025)Objective
To determine whether intensive long-term BP lowering with a low-dose triple single-pill combination reduces recurrent stroke risk after ICH compared to standard care
Study Summary
• Triple-pill significantly reduced recurrent stroke by 39% (HR 0.61, p=0.017; NNT=27)
• Recurrent ICH reduced by 60% (HR 0.40, p=0.003)
• Renal safety signal with more ≥30% eGFR reductions in treatment group (7.7% vs 4.3%)
• Recurrent ICH reduced by 60% (HR 0.40, p=0.003)
• Renal safety signal with more ≥30% eGFR reductions in treatment group (7.7% vs 4.3%)
Intervention
Low-dose triple single-pill combination (telmisartan 20 mg + amlodipine 2.5 mg + indapamide 1.25 mg) vs placebo
Inclusion Criteria
Adults with primary ICH, clinically stable, SBP 130–160 mmHg, completed 2-week single-blind active run-in phase
Study Design
Arms: Triple-pill vs placebo (on top of background care)
Patients per Arm: 459 triple-pill, 452 placebo (911 total)
Outcome
• Primary: Recurrent stroke reduced (HR 0.61, 95% CI 0.41–0.91, p=0.017)
• Recurrent ICH reduced (HR 0.40, 95% CI 0.22–0.72, p=0.003)
• MACE reduced (HR 0.67, 95% CI 0.47–0.94, p=0.020)
• No significant difference in CV death (HR 0.67, p=0.21)
• Recurrent ICH reduced (HR 0.40, 95% CI 0.22–0.72, p=0.003)
• MACE reduced (HR 0.67, 95% CI 0.47–0.94, p=0.020)
• No significant difference in CV death (HR 0.67, p=0.21)