Triple Therapy Prevention of Recurrent Intracerebral Disease EveNts Trial

  • End date
    Dec 25, 2023
  • participants needed
  • sponsor
    The George Institute
Updated on 25 January 2021
Grace Balicki
Primary Contact
Royal Melbourne Hospital (4.2 mi away) Contact
+85 other location
systolic blood pressure


An investigator initiated and conducted, multicentre, international, double-blinded, placebo-controlled, parallel-group, randomised controlled trial, to determine the effects of a fixed low-dose combination blood pressure lowering pill ("Triple Pill") on top of standard of care on blood pressure control, and on time to first occurrence of recurrent stroke, in patients with a history of acute intracerebral haemorrhage (TRIDENT).


Acute intracerebral haemorrhage (ICH) is the most serious and least treatable form of stroke, accounting for at least 10% of the 20 million new strokes that occur globally each year. Survivors of ICH are at high risk of recurrent ICH and other serious cardiovascular events.

While there is strong evidence that this risk can be reduced by lowering the blood pressure (BP) of patients after ICH, many patients with ICH do not receive BP-lowering treatment long-term unless BP levels are particularly high, and many do not receive BP combination therapy.

The aim of this study is to assess the safety and efficacy of a combination of fixed low-dose generic BP lowering agents, as a "Triple Pill" strategy on top of standard of care for the prevention of recurrent stroke in patients with a history of ICH and high normal or low grade hypertension. The study is a large-scale, international, double-blind, placebo-controlled, randomised controlled trial.

Condition Vascular Diseases, Hypertension, Diabetes and Hypertension, High Blood Pressure (Hypertension), High Blood Pressure (Hypertension - Pediatric), Elevated Blood Pressure, Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), Acute Intracerebral Haemorrhage (ICH), high blood pressure, arterial hypertension, Acute Intracerebral Haemorrhage (ICH)
Treatment Placebo, telmisartan 20mg, amlodipine 2.5mg, and indapamide 1.25mg
Clinical Study IdentifierNCT02699645
SponsorThe George Institute
Last Modified on25 January 2021


Yes No Not Sure

Inclusion Criteria

Adults (18 years) with a history of up to 12 months after symptom onset of primary ICH that is confirmed by imaging (copy of the brain imaging report to be uploaded to the database, labelled with participant identification (ID) and with personal identifiers removed)
Clinically stable, as judged by investigator
Average of two resting SBP levels measured 5 minutes apart in the range 130-160mmHg recorded in a seated position (National Heart Foundation of Australia Guidelines). (Patients with higher SBP can be included if considered by attending clinician that management is consistent with local standards of clinical practice)
Geographical proximity to the recruiting hospital and/or follow-up medical clinic site to allow ready access for in-person clinic visits during follow-up
No clear contraindication to any of the study treatments
Provision of written informed consent

Exclusion Criteria

Taking an ACE-I that cannot be switched to any of the following alternatives
telmisartan 20 or 40mg, amlodipine 2.5 or 5mg, indapamide 1.25mg, or
an equivalent class (ARB, CCB or thiazide [TZ]-like diuretic), or
a BB
Contraindication to any of the study medications, in the context of currently prescribed BP-lowering medication
Unable to complete the study procedures and/or follow-up
Females of child-bearing age and capability, who are pregnant or breast-feeding, or those of child-bearing age and capability who are not using adequate birth control
Significant hyperkalaemia and/or hyponatremia, in the opinion of the responsible physician
Estimated glomerular filtration rate (eGFR) <30mL/min/1.73m2
Severe hepatic impairment (alanine aminotransferase [ALT] or aspartate aminotransferase [AST] >3x the upper limit of normal [ULN])
Any other condition that in the opinion of the responsible physician investigator renders the patient unsuitable for the study (e.g. severe disability [i.e. simplified modified Rankin Scale (smRS) of 4-5] or significant memory or behavioural disorder)
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