Treatment with a combination medication made up of low doses of 3 antihypertensive drugs was associated with more patients reaching their target blood pressure (BP) than usual care, according to the results of a recent study.
In order to examine the effectiveness of a low-dose triple combination antihypertensive medication, researchers conducted a randomized, open-label trial involving 700 adults with hypertension (systolic BP >140 mm Hg and/or diastolic BP >90 mm Hg; or in patients with diabetes or chronic kidney disease: >130 mm Hg and/or >80 mm Hg) requiring initiation or escalation of antihypertensive treatment. The patients were enrolled from 11 hospital clinics in Sri Lanka from February 2016 to May 2017.
The patients were randomly assigned to receive either usual care or a once-daily fixed-dose triple combination pill containing 20 mg of telmisartan, 2.5 mg of amlodipine, and 12.5 mg of chlorthalidone. The primary outcome was the proportion of patients achieving target systolic-diastolic BP at 6 months, while secondary outcomes included mean systolic/diastolic BP difference during follow-up and the withdrawal of BP medications due to adverse events.
Overall, the triple combination pill was associated with a higher proportion of patients achieving target BP vs usual care at 6 months (70% vs 55%, respectively), and mean systolic/diastolic BP at 6 months was 125/76 mm Hg for the triple combination pill vs 134/81 mm Hg for usual care.
Over the course of the study, 419 adverse events were reported among 255 patients (38.1% of the triple combination pill group and 34.8% of the usual care group). The most common adverse events were musculoskeletal pain (6.0% and 8.0%, respectively) and dizziness, presyncope, or syncope (5.2% and 2.8%). Rates of participant withdrawal from therapy due to adverse events were 6.6% in the triple combination pill groups vs 6.8% in the usual care group.
“Among patients with mild to moderate hypertension, treatment with a pill containing low doses of 3 antihypertensive drugs led to an increased proportion of patients achieving their target BP goal vs usual care. Use of such medication as initial therapy or to replace monotherapy may be an effective way to improve BP control.”
Webster R, Salam A, de Silva A, et al. Fixed low-dose triple combination antihypertensive medication vs usual care for blood pressure control in patients with mild to moderate hypertension in Sri Lanka. JAMA. 2018;320(6):566-579.