Can a low-cost diuretic medication help to lower blood pressure after a stroke

Research Highlights:

• Adding the diuretic medication spironolactone to post-stroke care for adults with uncontrolled high blood pressure resulted in average systolic blood pressure (the top number) that was nearly 8 mm Hg lower at three months compared with usual post-stroke care. Spironolactone is a low-cost diuretic medication (or water pill) that helps the body excrete salt and water to prevent buildup, and it is usually added later in blood pressure treatment, typically when blood pressure stays high despite three other medications.
• In the REDUCE trial, patients taking spironolactone after a stroke were more likely to reach the recommended blood pressure goal of less than 130/80 mm Hg at three months than those receiving usual post-stroke care.
• In an exploratory analysis, blood pressure dropped more among people who started spironolactone within three months of their stroke than among those who started it later, researchers said.
• Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association's scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

Embargoed until 2 p.m. CT/3 p.m. ET, Saturday, Nov. 7, 2026

CHICAGO, Nov. 7, 2026 - Stroke survivors with uncontrolled high blood pressure who added an inexpensive diuretic medication called spironolactone to their treatment had lower blood pressure and reached the recommended blood pressure goal nearly twice as often as peers receiving usual post-stroke care, according to new, independent, preliminary late-breaking science presented today at the American Heart Association's Scientific Sessions 2026. The meeting on Nov. 6-9 in Chicago is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

"Strokes can be devastating and are a leading cause of disability. Our top goal is to keep patients from having another stroke," said the study's co-lead author Jordana B. Cohen, M.D., M.S.C.E., FAHA, an associate professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

"Lowering blood pressure is the most important step in preventing another stroke, yet many survivors struggle to reach recommended blood pressure targets after a stroke. When spironolactone was added to post-stroke care, we saw a meaningful drop in blood pressure that may lower the risk of future strokes and heart attacks," said Cohen, who is also a kidney and blood pressure specialist.

High blood pressure is a leading risk factor for having another stroke that can be controlled, according to the 2021 American Heart Association/American Stroke Association

Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Nearly 1 in 4 stroke survivors will have another stroke; however, up to 80% of strokes can be prevented. Having more than one stroke increases the risk severe disability and a poorer quality of life, Cohen noted.

Spironolactone is a long-available medication approved by the U.S. Food and Drug Administration to treat heart failure, high blood pressure, fluid buildup related to liver or kidney disease, and a hormone condition called primary hyperaldosteronism. It is also prescribed off-label for other conditions, such as acne and hair loss. However, this type of diuretic is usually the fourth recommended medication for high blood pressure, Cohen noted. Spironolactone lowers blood pressure by blocking aldosterone, a hormone that signals the kidneys to hold on to salt and water and to get rid of potassium. As a result, the body releases more salt and water but holds on to potassium, so people taking it must have their potassium levels checked regularly, she added.

This study, the Regulating Blood Pressure During Recovery from Intracerebral Hemorrhage and Ischemic Stroke (REDUCE) Trial, is a multicenter randomized clinical trial evaluating the addition of spironolactone for patients with uncontrolled high blood pressure after an ischemic stroke (clots) or intracerebral hemorrhage (bleeding). The primary outcome was home systolic blood pressure at three months.

What are the study's key findings?

• Three months after enrolling in the study, people taking spironolactone daily had a home-measured systolic blood pressure (top number) that was nearly 8 mm Hg lower on average than the standard care group - about 126 mm Hg vs. 133 mm Hg, respectively.
• Participants in the spironolactone group also had improved diastolic blood pressure (bottom number) at three months, dropping by about 4 mm Hg on average compared with those receiving standard post-stroke care.
• At three months, 52% of people taking the diuretic had reached the recommended blood pressure goal of less than 130/80 mm Hg, compared with 30% of people in the standard care group.
• At six months, people in the spironolactone group had systolic blood pressure that was about 7 mm Hg lower.
• The medication was well tolerated overall. Rates of serious side effects requiring hospitalization were similar between both groups: 15% in those taking spironolactone and 16% in those taking standard post-stroke medications. High potassium levels were present in about 4% of people in the spironolactone group, but it caused no life-threatening issues.

"We were surprised to see that blood pressure dropped twice as much as we expected. In an exploratory analysis, the blood pressure drop was larger in people who started this medication within three months after a stroke, " Cohen said. "We hope these findings encourage healthcare professionals to consider adding spironolactone sooner. In addition, we hope the results illustrate the importance of routine home blood pressure monitoring to reduce the increased cardiovascular disease risks associated with any level of high blood pressure, the #1 modifiable risk factor for cardiovascular disease."

What are the study's details, background, design and limitations?

• The REDUCE trial enrolled 160 adult stroke survivors, average age 63, (38% were women, and 29% of participants self-identified as Black adults and 16% as Hispanic adults). All participants in the study started with high blood pressure. On average, their systolic blood pressure was 136 mm Hg, measured at home.
• About half of participants had survived a hemorrhagic or bleeding stroke. The other half had an ischemic or clot-caused stroke.
• Participants enrolled between April 2021 and October 2025 at five U.S. medical centers: Yale New Haven Hospital, Hospital of the University of Pennsylvania, Atrium Health Wake Forest Baptist Medical Center, Temple University Hospital and University of Texas Health Science Center at Houston.
• Upon enrollment, participants tracked their blood pressure at home using a digital monitor for three to five days. They were then randomly assigned to receive daily spironolactone pills in addition to their regular medications, or to follow the usual post-stroke care recommended by their health care team that did not include spironolactone. Both the researchers and participants knew who was in the spironolactone group or the usual-care group.
• The researchers reviewed blood pressure readings from participants' at-home blood pressure monitoring devices at one, two, three and six months to track changes in blood pressure. They also noted how many medications each person was taking.
• Study limitations include that study compared spironolactone with usual care rather than with adding a different blood pressure medication; and people in the spironolactone group were taking slightly more blood pressure medications overall at three months (2.6 vs. 2.1, on average). Enrollment also ended early, at 160 of the planned 200 participants, and about 15% of participants did not have three-month blood pressure readings. The study was not designed to determine whether spironolactone lowers the risk of another stroke or heart attack, and larger, longer studies are needed to answer that question.

Co-authors, disclosures and author affiliations are listed in the abstract. The study was funded by a Bugher Center grant from the American Heart Association.

Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association's scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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Additional Resources:

• Multimedia is available on the right column of the release link
• View the abstract in the American Heart Association Scientific Sessions 2026 Online Program Planner
• American Heart Association news release: Managing high blood pressure could prevent >500K CVD deaths annually in 20 countries (Oct. 2026)
• American Heart Association news release: Many heart-related emergencies are due to uncontrolled blood pressure (Sept. 2022)
• American Heart Association/American College of Cardiology 2025 Joint Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults
• American Heart Association health information: Preventing Another Stroke
• American Heart Association health initiative: Target: BP
• About Scientific Sessions 2026
• For more news at the American Heart Association's Scientific Sessions 2026, follow us on X @HeartNews, #ScientificSessions26

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