Low-dose triple combination antihypertensive therapy for high blood pressure.

This study evaluated the effectiveness of a triple combination drug treatment of high blood pressure (BP) in one fixed-dose tablet. The authors concluded that one tablet containing a low-dose of 3 BP-lowering medications was more effective than usual care in controlling BP. 

High blood pressure (BP) remains one of the leading global public health problems. High BP can predispose people to stroke, heart attack, and heart failure. It is one of the leading conditions contributing to mortality worldwide. Monotherapy, as in treatment with one drug remains the current standard of care for high BP. However, this can contribute to poor BP control in some patients.

Combination therapy with inexpensive BP-lowering medications has the potential in improving BP control, especially in high-risk communities. However, taking more than one drug can decrease adherence to treatment. A drug containing more than one BP-lowering drug could improve adherence to treatment and BP control. The effectiveness of one such medication remains under investigation.

There were 700 patients with high BP enrolled in this clinical trial. Patients were randomly assigned to one of 2 groups. Group 1 received a pill containing 3 low-dose BP-lowering medications: 20mg telmisartan (Micardis), 2.5 mg amlodipine (Norvasc), and 12.5 mg chlorthalidone (Thalitone). Group 2 received standard care. Patients were followed up for 6 months.

At 6-months, 69.5% of patients in group 1 had achieved the BP target compared to 55.3% in group 2. The average BP in group 1 was 125/76 mmHg compared to 134/81 mmHg at 6 months.

Adherence to the medication schedule was high in both groups (95.0% in group 1 vs 94.6% in group 2). Overall, 38.1% of patients in group 1 reported at least 1 side effect. This was compared to 34.8% in group 2. The most common adverse events were muscle and bone pain, dizziness, and fainting. 

The authors concluded that in patients with mild to moderate high BP, treatment with one pill with low doses of 3 antihypertensive drugs led to more patients achieving their target BP goal when compared to the current standard of care. 

This study was carried out on a Sri Lankan population and so it may not translate to a global population.