AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Effects of a Novel Low-Dose Triple Combination Antihypertensive Pill in People with Prior Intracerebral Haemorrhage by eGFR Status: Results from the TRIDENT Trial
By Wang X, Van Der Hoon S, Kotwal SS et al.
BACKGROUND Effective blood pressure (BP) lowering reduces recurrent stroke after intracerebral haemorrhage (ICH). Chronic kidney disease is common in this population but evidence is limited on whether the effects of BP-lowering on stroke prevention are consistent across levels of kidney function. HYPOTHESIS The treatment effect of GMRx2 on the primary outcome is consistent across eGFR strata at screening. METHODS TRIDENT was a multinational, double-blind, randomized, placebo-controlled trial in adults with prior ICH and a systolic BP of 130-160 mmHg who completed a 2-week single-blind active run-in. Of the 2206 who entered the active run-in, 536 (23%) were not randomised, the most common reason being creatinine rise of >20% in 147 (6.7%). Participants were randomized to GMRx2 (telmisartan 20mg, amlodipine 2.5mg, indapamide 1.25mg) or matching placebo, on top of usual care. The primary outcome was recurrent stroke. In this post hoc analysis, the treatment effect was estimated within estimated glomerular filtration rate (eGFR) categories defined at the screening visit (30-59, 60-89, ≥90 mL/min/1.73m ² ) using a Cox proportional hazard model adjusted for stratification variables (country, age <65 vs ≥65 years, baseline SBP <140 vs ≥140 mmHg) as fixed effects, with a treatment-by-subgroup interaction term. RESULTS Of 1670 participants randomized at 57 sites in 10 countries (mean age 58 years, 34% female), mean SBP at screening was 143/88 mmHg on a mean of 1.1 background BP-lowering medications; screening eGFR (mL/min/1.73m ² ) was 30-59 in 204, 60-89 in 681 and ≥90 in 784. Overall, GMRx2 reduced recurrent stroke versus placebo (HR 0.61, 95% CI 0.41-0.92; Table 1), with directionally consistent effects across eGFR strata (p for interaction = 0.28). Stroke rates were markedly higher in the eGFR <60 group (8-11%) than in those with eGFR ≥90 (3-4%). Similar findings were observed for major cardiovascular events. CONCLUSIONS GMRx2 reduces the risk recurrent stroke in people with prior ICH, across all strata of kidney function above 30 mL/min/1.73m ² . Recurrence rates were markedly higher in those with mild to moderate CKD.