ESOC 2026 | Pooled analysis of trials exploring blood pressure lowering after intracerebral hemorrhage

So the significance of the TRIDENT trial is to show conclusively that more intensive blood pressure lowering, a target less than 130 millimeters of mercury systolic, benefits patients with intracerebral hemorrhage. Intracerebral hemorrhage is a highly blood pressure dependent disease. The better we get blood pressure under control, the benefits to the patient. And in TRIDENT, we showed a low dose triple combination antihypertensive achieve this. And this medication will be available on the market over the next couple of years. But in a single trial, you don’t have enough statistical power to look at how the treatment varies according to particular patient subgroups. And the other thing is that in TRIDENT, we showed an interesting time delay of about a year before there was a benefit of the treatment. And so it questioned whether that’s a biological phenomenon, that it takes a while for the endothelium of the blood vessels to remodel with blood pressure lowering, or whether it’s just a chance effect with small numbers of events. So what we’ve done is we’ve pulled TRIDENT data with other trials of intensive blood pressure lowering that have included large numbers of patients with intracerebral haemorrhage. The original PROGRESS trial, some 25 years ago now, which has been pooled with RESPECT, a Japanese trial, and ESPRIT, which was a Chinese trial, and TRIDENT. Altogether, it’s almost 3,000 patients with intracerebral hemorrhage where we can look at the relationship between blood pressure lowering according to patient characteristics. The bottom line is that intensive blood pressure lowering was consistent according to age, sex, ethnicity, baseline blood pressure, background treatment, where the hematoma is very consistent effect. And the other very important effect is the benefits of the treatment, the separation of the curves between the intensive group and the control group happened very early. Statistically, you had the significant result in about six weeks, but the curves were deviating within the first weeks or so. So blood pressure lowering works quickly, like antiplatelet therapy, anticoagulation, cholesterol lowering. So therefore, the earlier we can get blood pressure under control, the better we can sustain it, the more benefits to the patients.

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