ESOC 2026 | New strategies to improve blood pressure control and prevent recurrent stroke

I think we realise now that we have to do better for secondary prevention. Once the patient leaves hospital, follow-up in specialist care is pretty fragmented and inadequate. We also know that if you can get the secondary prevention initiated well in hospital, that tends to be followed on in primary care. So we have to look at other strategies that can improve secondary prevention. Patient adherence remains an issue. It’s often very difficult for them to feel secondary prevention working or understand the necessity of taking the medication long term. There’s always concern that if we’re overly aggressive with blood pressure control, it may cause harm, particularly in the frail elderly. We’ve been investigating the combination antihypertensive pill approach and we evaluated that in the TRIDENT trial with patients with intracerebral haemorrhage and we showed an additional booster benefit in terms of blood pressure control on top of standard of care, an extra 9mm systolic boost in their blood pressure control, and that translated into a 40% reduction in their risk of recurrent stroke. The advantage of a triple low-dose combination antihypertensive is its simplicity. You get an extra boost of efficacy and blood pressure control and without any of the harms that you’d get with full-dose medication. So this is a good strategy, but we need to test it out more in clinical practice because it’s quite a novel approach and most clinicians are taught and apply the standard stepped dose escalation approach in clinical practice, but as we know that’s not working optimally in clinical practice all around the world, so we need to look at other ways to improve secondary prevention into the community that are scalable.

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