Intensive blood pressure-lowering treatment reduces the risk of recurrent stroke by 38% in adults who have survived an intracerebral haemorrhage, according to a major meta-analysis published in The Lancet Neurology. The findings show that targeting specific blood pressure thresholds prevents recurrent strokes without increasing serious adverse events.
Meta-Analysis Reveals 38% Drop in Recurrent Stroke Risk
Long-term blood pressure-lowering treatment cuts the risk of recurrent stroke by 38% in people who have survived an intracerebral haemorrhage, according to a meta-analysis published in The Lancet Neurology.
Australian researchers examined data from four randomised controlled trials involving 2,944 adults with intracerebral haemorrhage, maintaining a maximum follow-up period of six years. Two of the trials evaluated fixed-dose antihypertensive therapies, while the other two investigated treatment strategies structured around defined blood pressure targets. Among the evaluated studies, TRIDENT was the sole trial that exclusively enrolled patients with spontaneous intracerebral haemorrhage, whereas the remaining studies included individuals with either ischaemic stroke or intracerebral haemorrhage at baseline.
Recurrent stroke of any type occurred in 6.5% of patients assigned to intensive blood pressure-lowering therapy, compared with 10.4% of patients in the control arm receiving less intensive treatment or standard care. This reduction was primarily driven by an approximate 61% lower risk of intracerebral haemorrhage among patients managed with intensive treatment.
Clinical Targets and Safety Profiles Across Trial Groups
During the follow-up period, the average systolic blood pressure reached 127mmHg in the intensive treatment group and 138mmHg in the control group, establishing a mean difference of 11.2mmHg. Subgroup evaluations demonstrated that the advantages of intensive blood pressure reduction remained consistent irrespective of the time elapsed since the initial intracerebral haemorrhage event.
Patients whose baseline blood pressure already sat at conventional targets continued to face substantial risk and still benefited from further lowering. For instance, among individuals with a baseline systolic blood pressure of 130mmHg or lower, recurrent stroke developed in 13.9% of control-arm patients versus 6.2% of those receiving intensive treatment.
“Generally, guidelines recommend treatment to a target of less than 130/80mmHg, but our study showed that patients at or below this threshold can still face a significant risk of recurrent stroke.”
Craig Anderson, senior author at The George Institute in Sydney, Australia
Serious adverse events showed no significant difference between the study arms, occurring in approximately 29% of patients in the intensive treatment group and 33% of patients receiving standard care.
Expert Perspectives on Secondary Prevention Challenges
Senior study author Craig Anderson, a senior professorial fellow at The George Institute for Global Health in Sydney, Australia, emphasised the clinical weight of the findings in light of the condition’s severity.
“Our analysis shows that intensive blood pressure treatment can prevent 16 recurrent strokes for every 1,000 patients treated within the first year alone. These findings reinforce the central role of blood pressure control in secondary stroke prevention.”
Craig Anderson, senior professorial fellow at The George Institute for Global Health
Paul Wright, a consultant cardiovascular pharmacist at Barts Health NHS Trust in London, noted that while the medical community has long accepted that lower blood pressure yields better outcomes, practical application remains challenging.
“Most physicians would go for a ‘lower is better’ based approach. The difficulty is how you get blood pressure lower without adverse effects — that is the trade-off, although this data showed compelling reduction with limited adverse effects.”
Paul Wright, consultant cardiovascular pharmacist at Barts Health NHS Trust in London
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