People who survived a bleeding stroke appeared to get similar protection from a low-dose, three-drug blood pressure pill whether or not their kidneys were working well, according to a new analysis presented Nov. 9 at the American Heart Association's Scientific Sessions in Chicago. The pill's developer, George Medicines , announced the findings.
The analysis is post hoc, meaning researchers looked at the data in a way the trial was not designed to test. It cannot prove the pill works equally well in every kidney group, and some of the subgroup results were not statistically significant on their own.
Still, the question matters to many families. Kidney disease is common after a brain bleed and is linked to about twice the risk of stroke, so doctors and patients often worry about how hard to push blood pressure treatment when the kidneys are already strained.
An intracerebral hemorrhage happens when a blood vessel ruptures inside the brain. It is the most severe type of stroke, with more than 3 million new cases worldwide each year, according to The George Institute for Global Health , which led the trial. About one-quarter of survivors later die from another stroke or heart disease.
High blood pressure is the main driver, and many survivors never reach their target. " Lowering blood pressure is the only proven method to prevent another stroke," said Professor Craig Anderson, the trial's principal investigator.
TRIDENT enrolled 1,670 adults with a past brain bleed and systolic blood pressure between 130 and 160. They took either a once-daily pill containing telmisartan 20 mg, amlodipine 2.5 mg, and indapamide 1.25 mg, or a placebo, on top of usual care. Results were published in April in The New England Journal of Medicine.
Over a median of 2.5 years, recurrent stroke occurred in 4.6% of the pill group and 7.4% of the placebo group, a 39% lower risk, according to an American College of Cardiology summary . Average systolic pressure was 127 in the pill group and 138 on placebo. Major heart and stroke events fell from 9.8% to 6.6%.
The new analysis grouped patients by estimated glomerular filtration rate, or eGFR, a blood test measure of kidney function. Lower numbers mean weaker kidneys, and values below 60 generally indicate chronic kidney disease.
Among people with eGFR below 60, recurrent stroke occurred in 8% on the pill and 11% on placebo. In the 60 to 89 group, the rates were 5% and 10%. In people with normal kidney function 90 or higher, the rates were 3% and 4%. A statistical test found no clear difference in the pill's effect across the three groups.
Only the middle group showed a statistically significant benefit on its own, a pattern that calls for caution. The confidence ranges in the other two groups were wide, a sign of small numbers, and the release did not report how many patients were in each group.
Serious side effects were similar overall, at 23.8% with the pill and 26.9% with placebo. In the group with kidney disease, they were lower with the pill, 26.4% versus 42.7%, and the difference in serious side effects varied across kidney groups. The release did not break out kidney-specific side effects.
"In this analysis, the effect of GMRx2 on recurrent stroke was consistent, regardless of kidney function, which is encouraging," said Mark Mallon, chief executive of George Medicines. The company has not said when the full analysis will be published.
The trial was led by The George Institute and funded by Australia's National Health and Medical Research Council and Brazil's Ministry of Health. George Medicines, a spinout of The George Institute, supplied the study medication and has a financial interest in the results.
Kidney safety is not settled. In the main trial, 13.6% of pill users stopped treatment because of side effects, compared with 6.0% on placebo, most often because of a rise of 20% or more in creatinine, a kidney blood marker, according to a European Academy of Neurology review . The trial's authors suggested the rise may reflect a change in blood flow rather than worsening kidney disease.
About 73% of TRIDENT participants were Asian, and two-thirds lived in Sri Lanka. That could limit how well results apply to U.S. patients, who may differ in kidney disease severity and the number of medicines they take.
The pill is already available in the U.S. The FDA approved it as Widaplik in June 2025 for high blood pressure. It is not specifically approved to prevent repeat strokes, and its label carries a boxed warning against use during pregnancy.
Brain bleed survivors with chronic kidney disease, diabetes, or heart disease face a higher risk of another event, and they are also the patients most likely to be juggling several prescriptions. Caregivers often manage pill boxes and blood pressure logs, which makes a simpler regimen appealing.
Survivors can ask their doctor what their blood pressure target is and whether they are reaching it at home. A home monitor and a written log can help guide changes between visits.
Those with kidney disease can ask how often their kidney function and potassium should be checked after any change. Combination pills that include an ARB and a diuretic can raise creatinine or shift sodium and potassium levels, so lab monitoring matters.
No one should switch or stop blood pressure medicine on their own. Dizziness, fainting, sharply reduced urination or confusion after a medicine change should be reported promptly. A sudden severe headache, weakness on one side, slurred speech or vision loss requires a 911 call, because those can be signs of another stroke.
Cost may be a barrier for a newer brand-name combination. Patients can ask whether taking the same three drugs separately as generics would be cheaper, or whether their insurer covers the single pill.
George Medicines has not said whether it will seek a stroke-prevention claim. MedicalDaily will report on any full publication of the kidney analysis or regulatory filings.
What is a brain bleed? An intracerebral hemorrhage, the most severe type of stroke, caused by a burst blood vessel in the brain.
What did the original TRIDENT trial show? A once-daily low-dose triple pill lowered recurrent stroke risk by 39% compared with placebo over about 2.5 years.
What did the new analysis find? The pill's effect on recurrent stroke did not differ clearly by kidney function. Only one kidney subgroup reached statistical significance alone.
Is this analysis definitive? No. It was post hoc and not designed to prove benefit in each kidney group.
Is the pill available? Yes. It is FDA-approved as Widaplik for high blood pressure, not specifically for stroke prevention.
What should people with kidney disease ask? How often kidney function and potassium will be checked, and what their blood pressure target should be.
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