{"id":"785175fa3473","type":"article","url":"https://hartvaat.nl/2026/04/23/triple-pill-verlaagt-risico-op-terugkerende-beroerte-na-hersenbloeding/","title":"Triple-pill verlaagt risico op terugkerende beroerte na hersenbloeding","title_en":"","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["aspirine","dubbele-trombocytenremming","trombocytenaggregatieremmers"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2515043","source_url":"https://doi.org/10.1056/NEJMoa2515043","authors":["Craig S Anderson","Clara K Chow","H Asita de Silva","Bimsara Senanayake","Kolawole Wahab","Rustam Al-Shahi Salman","Catharina J M Klijn","Sheila Ouriques Martins","Natalie Espinosa","Lauren Kuhles","Laurent Billot","Hisatomi Arima","Cheryl Carcel","Xia Wang","Qiang Li","Sana Shan","Mathangi Shanthakumar","Huy Thang Nguyen","Dilum Palliyaguruge","Janaka Peiris","Udaya K Ranawaka","Senaka Bandusena","Thambipillai Rajendiran","Darshana Wijegunasinghe","Harsha Gunasekera","Indunil Wijeweera","Athula Dissanayake","Ajantha Keshavaraj","Reginald O Obiako","Rufus Akinyemi","Luiz Nasi","Rodrigo Bazan","Carla Heloisa Cabral Moro","Mariana Battaglini","Viviane Zétola","Wan Chung Law","Yuen Kang Chia","Dennis Cordato","Rohan Grimley","Anuradha Dahanayaka","Sonali Liyanagamage","Nilukshi Fernando","Nihara Abdul Rasheed","Nodar Kakabadze","Maia Beridze","Mythily Aravinthan","Vithoosan Sahathevan","Devasmitha Wijesundara","Pramith Ruwanpathirana","Wan Asyraf Wan Zaidi","Tinatin Kherkheulidze","Urs Fischer","Ana Cláudia de Souza","Tsong-Hai Lee","Christopher Chen","Octavio Pontes-Neto","Thompson Robinson","Jiguang Wang","Sharon L Naismith","Michael Barnett","Carlos Delfino","Shoujiang You","Feifeng Liu","Candice Delcourt","Tom J Moullaali","Tim Wilkinson","Neil Watson","Karla Santo","Qiao Han","Mariana Almudi Souza","Wilmar M T Jolink","Anderson Berni Cristofari","Zien Zhou","Floris H Schreuder","Richard I Lindley","Manuela Armenis","Mark Woodward","Ruth Freed","Lili Song","John Chalmers","Anthony Rodgers"],"significance":10,"published":"2026-04-30","source_date":"2026-04-23","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/"],"congress":"","summary_en":"In a multinational double-blind RCT of 1670 patients with prior intracerebral haemorrhage, a once-daily low-dose triple pill (telmisartan 20 mg, amlodipine 2.5 mg and indapamide 1.25 mg) added to standard care reduced recurrent stroke by 39% (4.6% vs 7.4%; HR 0.61) over 2.5 years, with mean systolic BP of 127 vs 138 mmHg. Major cardiovascular events were also lower (6.6% vs 9.8%). Early discontinuation for adverse events — mainly serum creatinine rises — was more common with the triple pill (13.6% vs 6.0%).","created":"2026-07-03T10:32:49Z","updated":"2026-07-03T13:31:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een multinationale dubbelblinde RCT onder 1670 patiënten met een hersenbloeding in de voorgeschiedenis verlaagde een dagelijkse driecombinatiepil (telmisartan 20 mg, amlodipine 2,5 mg, indapamide 1,25 mg) bovenop standaardtherapie het risico op een tweede beroerte met 39% (4,6% vs 7,4%; HR 0,61) over 2,5 jaar. De gemiddelde systolische bloeddruk daalde naar 127 versus 138 mmHg en majeure cardiovasculaire events kwamen minder vaak voor (6,6% vs 9,8%). Vroege staking wegens bijwerkingen — vooral creatininestijging — was wel hoger in de triple-pillgroep (13,6% vs 6,0%).","abstract_original":"BACKGROUND: Blood-pressure reduction is the only proven treatment to prevent stroke. Whether a single pill that combines three antihypertensive drugs at low doses, in addition to standard antihypertensive treatment, can lower blood pressure more than standard care alone and reduce the risk of recurrent stroke after intracerebral hemorrhage is uncertain. METHODS: We conducted a multinational, double-blind, randomized, placebo-controlled trial involving patients with a history of intracerebral hemorrhage. Patients were eligible for the trial if they had a systolic blood pressure of 130 to 160 mm Hg at baseline and were in clinically stable condition. After a 2-week active run-in phase during which all the patients received a once-daily pill containing three antihypertensive agents at low doses (telmisartan at 20 mg, amlodipine at 2.5 mg, and indapamide at 1.25 mg; the triple pill), the patients were randomly assigned to continue receiving the triple pill or to receive matching placebo. The primary outcome was the first recurrent stroke. Secondary outcomes included blood-pressure control, major cardiovascular events, death from cardiovascular causes, and safety. RESULTS: Of 1670 patients who underwent randomization, 833 were assigned to receive the triple pill and 837 to receive placebo. The mean age of the patients was 58 years. At a median follow-up of 2.5 years, recurrent stroke had occurred in 38 patients (4.6%) in the triple-pill group and 62 (7.4%) in the placebo group (hazard ratio, 0.61; 95% confidence interval [CI], 0.41 to 0.92; P = 0.02). The mean systolic blood pressure during follow-up was 127 mm Hg and 138 mm Hg, respectively. The incidence of major cardiovascular events was lower with the triple pill than with placebo (6.6% vs. 9.8%; P = 0.04). Serious adverse events occurred in 23.2% of the patients in the triple-pill group and 26.0% of those in the placebo group. Early discontinuation of the trial regimen due to an adverse event occurred in 13.6% and 6.0%, respectively. The most common adverse event leading to discontinuation was an increase of 20% or more in the serum creatinine level. CONCLUSIONS: Among patients with intracerebral hemorrhage, treatment with a combination of three low-dose antihypertensive agents in a single pill, in addition to standard care, was associated with a lower incidence of recurrent stroke and major cardiovascular events than placebo. (Funded by the National Health and Medical Research Council of Australia and the Brazilian Ministry of Health; TRIDENT ClinicalTrials.gov number, NCT02699645; Australian New Zealand Clinical Trials Registry number, ACTRN12616000327482.)."}