Beyond the Window – What ISC 2026 Tells Us About Treating Stroke Earlier or Later

Blood Pressure Control: Which Patients May Benefit Most From Specific Strategies?

How should clinicians think about hypertension in 2026? In this episode of Voice of Stroke, we explore recent evidence addressing one of the most important questions in vascular prevention: not simply whether to lower blood pressure, but which treatments work best, who should be treated, and how hypertension-related vascular disease may influence stroke mechanisms and secondary prevention. This episode discusses: * Meta-analyses evaluating the efficacy and tolerability of antihypertensive drugs and combinations * Blood pressure lowering in isolated diastolic hypertension * An exploratory analysis of the ARCADIA trial examining high-risk hypertension features and recurrent stroke prevention Featuring discussion of recent studies published in The Lancet, JAMA, European Heart Journal and JAMA Neurology. Written by Voice of Stroke Podcast Editor-In-Chief Linxin Li and Co-Editor Maria Magdalena Gabriel. Read the full transcript here. [https://eso-stroke.org/wp-content/uploads/ESO-Podcast_EP5_Transcript.pdf] References * Ridha M et al. Hypertension With High-Risk Features in Cryptogenic Stroke: An Exploratory Analysis of the ARCADIA Randomized Clinical Trial. JAMA Neurology. 2026. * Bidel Z et al. Blood pressure lowering in isolated diastolic hypertension and cardiovascular risk: an individual patient data meta-analysis. European Heart Journal. 2026. * Wang N et al. Blood pressure-lowering efficacy of antihypertensive drugs and their combinations. The Lancet. 2025. * Wang N et al. Adverse Effects and Treatment Discontinuation of Blood Pressure-Lowering Drugs and Combinations. JAMA. 2026. * Blood Pressure Treatment Efficacy Calculator: https://www.bpmodel.org/blood-pressure-treatment-efficacy-calculator/ [https://www.bpmodel.org/blood-pressure-treatment-efficacy-calculator/]

Intracerebral Haemorrhage – From Blood Pressure Control to Secondary Brain Injury

In this episode of Voice of Stroke we explore major recent advances in intracerebral haemorrhage research. This episode discusses: * The TRIDENT trial and long-term blood pressure lowering after ICH * Perihaematomal oedema growth as a biomarker of secondary brain injury * Translational neuroimmunology and inflammatory signalling after haemorrhage * Highlights from the ESO ICH Academy Meeting in Maastricht Featuring discussion of recent publications in the New England Journal of Medicine, Stroke, and Annals of Neurology. Written by Voice of Stroke Podcast Editor-in-Chief Linxin Li and Co-editor Annemijn Algra. Listen on Spotify, Apple Podcasts, and via the European Stroke Organisation website. Read the full transcript here [https://eso-stroke.org/wp-content/uploads/ESO-Podcast-EP4_Transcript.pdf]. References 1. The Trident Research Group. Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage. N Engl J Med. 2026; 394: 1571-1582. doi: 10.1056/NEJMoa2515043. https://www.nejm.org/doi/full/10.1056/NEJMoa2515043 2. Samarasekera N et al. Perihematomal Edema and Functional Outcome After Intracerebral Hemorrhage: A Meta-Analysis of Individual Participant Data. Stroke 2026; 57: 1310-1324. doi: 10.1161/STROKEAHA.125.053991. https://www.ahajournals.org/doi/epdf/10.1161/STROKEAHA.125.053991 3. Parry-Jones A et al. Hematoma Interleukin-1 ReceptorAntagonist Concentrations PredictLong-Term Outcome in AcuteHuman Intracerebral Hemorrhage. Ann Neurol 2026; 00: 1-16. doi: 10.1002/ana.78237. https://onlinelibrary.wiley.com/doi/epdf/10.1002/ana.78237 4. ICH Academy Meeting: https://eso-stroke.org/resources/eso-ich-academy-meeting-iam/

Atrial Fibrillation and Stroke Prevention – What's New?

In this episode of Voice of Stroke, we explore the latest evidence shaping stroke prevention in atrial fibrillation (AF) – a condition responsible for up to a quarter of all ischaemic strokes. This episode examines emerging strategies and unresolved questions in AF management, including: * Whether left atrial appendage closure (LAAC) can replace anticoagulation in patients eligible for oral therapy * The role of catheter ablation in reducing recurrent stroke risk after AF-related stroke * New population data on blood pressure control and stroke risk, particularly in younger AF patients Key insights: * Anticoagulation remains the cornerstone of stroke prevention, but limitations persist * LAAC may reduce bleeding risk but does not yet clearly outperform anticoagulation in eligible patients * Catheter ablation did not reduce recurrent stroke risk in current trial evidence * Blood pressure is a critical—and potentially under-recognised—driver of stroke risk in AF, especially in younger populations Together, these findings refine how we approach AF stroke prevention, balancing procedural interventions, pharmacological therapy, and risk factor management. This episode was written by Voice of Stroke Podcast editor Umberto Pensato and Editor-in-Chief Linxin Li. Read the full transcript here [https://eso-stroke.org/wp-content/uploads/ESO-Podcast-EP3_Transcript.pdf]. ----- References Landmesser U et al. Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation. N Endl J Med. 2026; 394: 1270-1280. doi: 10.1056/NEJMoa2513310. https://www.nejm.org/doi/full/10.1056/NEJMoa2513310 [https://www.nejm.org/doi/full/10.1056/NEJMoa2513310] Doshi SK et al. Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation. N Engl J Med. 2026 Mar 28. doi: 10.1056/NEJMoa2517213 https://www.nejm.org/doi/full/10.1056/NEJMoa2517213 [https://www.nejm.org/doi/full/10.1056/NEJMoa2517213] Kimura K et al. Catheter Ablation and Oral Anticoagulation for Secondary Stroke Prevention in Atrial Fibrillation: The STABLED Randomized Clinical Trial. JAMA Neurol. 2026 Mar 2:e260155. doi: 10.1001/jamaneurol.2026.0155. https://jamanetwork.com/journals/jamaneurology/fullarticle/2845745 [https://jamanetwork.com/journals/jamaneurology/fullarticle/2845745] Jeong MH et al. Impact of blood pressure on the risk of stroke and all-cause mortality in patients with atrial fibrillation across different age groups: a nationwide population-based study. Heart Rhythm. 2026 Mar 24:S1547-5271(26)02172-7. doi: 10.1016/j.hrthm.2026.03.1917. https://www.heartrhythmjournal.com/article/S1547-5271(26)02172-7/fulltext [https://www.heartrhythmjournal.com/article/S1547-5271(26)02172-7/fulltext]

What's new in the field of lipids, and can it help us prevent stroke?

In this episode of Voice of Stroke, we explore new evidence shaping how lipid management can reduce stroke risk across both primary and secondary prevention. This episode explores: * Reassessing statin side effects using large-scale randomised trial data * The role of PCSK9 inhibition (VESALIUS-CV) in reducing vascular events in high-risk patients without prior stroke * Long-term data linking LDL, lipoprotein(a), and inflammation to stroke risk decades later Together, these findings clarify safety concerns, expand preventive options, and highlight the importance of long-term risk prediction in stroke care. This episode was written by Linxin Li, Editor-in-Chief of the Voice of Stroke Podcast, and Co-Editor Ahmad Nehme. Note: Full transcript available here. [https://eso-stroke.org/wp-content/uploads/ESO-Podcast_EP2_Transcript.pdf] The following publications were mentioned in this podcast: * NEJM paper on the VESALIUS-CV trial [https://www.nejm.org/doi/full/10.1056/NEJMoa2514428] * Lancet paper on statin side effects [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01578-8/fulltext] * Lancet Neurology paper on prediction of long-term stroke risk [https://www.sciencedirect.com/science/article/pii/S1474442225003060] * 2026 AHA/ACC guideline on lipid management [https://www.ahajournals.org/doi/10.1161/CIR.0000000000001423] * International Journal of Stroke review on lipid management [https://journals.sagepub.com/doi/10.1177/17474930261418388]

Beyond the Window – What ISC 2026 Tells Us About Treating Stroke Earlier or Later

In this first episode of Voice of Stroke, we examine three key trials presented at ISC 2026 that challenge how we define time boundaries in acute stroke care. This episode explores: · Extending intravenous thrombolysis beyond 4.5 hours in non-large vessel occlusion stroke (OPTION) · Tenecteplase within 24 hours for basilar artery occlusion (TRACE-5) · Ultra-early recombinant factor VIIa in intracerebral haemorrhage (FASTEST) Together, these trials refine our understanding of patient selection, risk, and benefit across ischaemic and haemorrhagic stroke. This month's Voice of Stroke episode was written by Linxin Li, Editor-in-Chief of the Voice of Stroke Podcast. Read the full transcript here [https://eso-stroke.org/wp-content/uploads/ESO-podcast_EP1_Transcript.pdf].