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People who have had an intracerebral haemorrhage (ICH) — a type of haemorrhagic stroke — have a reduced risk of further stroke if their treatment aims for defined blood pressure targets rather than following a fixed-dose antihypertensive regimen, according to study results published in The Lancet Neurology.
The meta-analysis by Australian researchers looked at four randomised controlled trials involving people with ICH, two of which involved fixed-dose antihypertensive therapies and two which looked at treatment strategies based on defined blood pressure targets. There were 2,944 adults across all four trials, with a maximum follow-up period of six years.
The authors reported that recurrent stroke of any type occurred in 6.5% of patients receiving intensive blood pressure-lowering therapy. This compared with 10.4% of the control group, who were defined as taking less intensive treatment or standard antihypertensive care.
The authors note that this translates to a 38% reduction in recurrent stroke risk, which they say is because intensive blood pressure-lowering treatment helps prevent recurrent haemorrhage.
They also said that there was no significant difference in serious adverse events between the two groups.
Haemorrhagic strokes account for around 15% of all strokes. The Stroke Association says that ICH is the most common type of haemorrhagic stroke, making up around two-thirds of all haemorrhagic strokes.
According to Brain Research UK, strokes of all kinds cause around 34,000 deaths per year in the UK.
Study author Craig Anderson, senior professorial fellow at The George Institute for Global Health in Sydney, Australia, said: “Intracerebral haemorrhage is one of the deadliest forms of stroke, with limited treatment options and a high risk of recurrence among survivors.
“Our analysis shows that intensive blood pressure treatment can prevent 16 recurrent strokes for every 1,000 patients treated within the first year alone. These findings reinforce the central role of blood pressure control in secondary stroke prevention.”
Commenting on the study, Paul Wright, consultant cardiovascular pharmacist at Barts Health NHS Trust in London, said the study was “impactful and interesting, although we have known for some time that lower is better”.
“Part of the problem though, is how you translate that into practise.
“Most physicians would go for a ‘lower is better’ based approach. The difficulty is how you get blood pressure lower without adverse effects — that is the trade-off, although this data showed compelling reduction with limited adverse effects.”
A study published in the New England Journal of Medicine in April 2026 found that GMRx2 — a single pill combination of three low-dose blood pressure medicines — significantly reduced the risk of another stroke in patients with intracerebral haemorrhage and high blood pressure.
