A major international clinical trial has found that a once-daily, three-in-one blood pressure pill can significantly reduce the risk of recurrent strokes among patients who have survived a brain bleed, or haemorrhagic stroke, Kelaniya University’s media division announced yesterday.

The TRIDENT trial, coordinated in Sri Lanka by a team led by Senior Professor Asita de Silva of the Clinical Trials Unit, Faculty of Medicine, University of Kelaniya, showed that the low-dose combination pill reduced the risk of a repeat stroke by up to 40 per cent and the risk of another brain bleed by 60 per cent among high-risk patients. The findings were published on April 23 in the New England Journal of Medicine.

The pill combines three commonly used antihypertensive medications—amlodipine, telmisartan and indapamide—into a single daily dose. Researchers said the simplified regimen improves patient adherence and supports better blood pressure control, a key factor in preventing further strokes, heart attacks and other cardiovascular complications.

The trial followed 1,670 stroke survivors across 11 countries over a seven-year period, including participants from 11 specialist neurology centres in Sri Lanka. Nearly 73 per cent of participants were Asian, with close to 70 per cent from Sri Lanka, making the findings particularly relevant to the country and the wider South Asian region.

An estimated 60,000 people in Sri Lanka suffer strokes annually, while cardiovascular disease accounts for more than 40 per cent of all deaths. Around 40 per cent of Sri Lankan adults aged 30 to 79 are affected by high blood pressure, the leading risk factor for stroke.

Professor de Silva said a decade of clinical trials involving Sri Lankan and international researchers had consistently shown the effectiveness of a triple low-dose combination therapy in controlling blood pressure. He noted that the drug has recently been approved by the U.S. Food and Drug Administration and included in the World Health Organization’s Model List of Essential Medicines. He described the findings as a “game changer” in reducing recurrent stroke risk through sustained blood pressure control.

He also highlighted Sri Lanka’s significant contribution to the study, noting that nearly 70 per cent of the trial data was generated locally, underscoring the country’s growing role in global medical research.

Dr. Bimsara Senanayake, Specialist Neurologist and Lead Investigator at the National Hospital of Sri Lanka, said the findings address longstanding gaps in the treatment of intracerebral haemorrhage, where effective strategies for intensive blood pressure management have remained uncertain for decades. He noted that improved blood pressure control could substantially reduce the risk of further life-threatening events among survivors.

In a statement, World Stroke Organization President Professor Jeyaraj Pandian described the trial as a major advance in stroke prevention, highlighting the benefits of effective blood pressure management following intracerebral haemorrhage.

The findings are expected to inform changes in clinical practice, particularly as the triple-combination pill used in the trial has already received regulatory approval and global recognition for the treatment of hypertension.

Dr. Ajantha Keshavaraj, President of the Association of Sri Lankan Neurologists and a co-author of the study, said the results could significantly change the management of post-stroke blood pressure, adding that the treatment—combined with lifestyle measures such as reduced salt intake—has the potential to save thousands of lives.

An accompanying editorial in the New England Journal of Medicine also underscored the importance of strict blood pressure control as a priority in preventing cardiovascular disease.