A new
low-dose antihypertensive combination drug, containing medications belonging to
different class, may have the potential to revolutionize treatment of hypertension
globally. This ‘triple pill’ contains three antihypertensive drugs: Telmisartan
(20 mg), amlodipine (2.5 mg) and chlorthalidone (12.5 mg).
A
randomized clinical trial, the TRIUMPH trial, which was conducted in Sri Lanka
compared once-daily low-dose triple antihypertensive combination drug with
usual care in 700 patients with with mild to moderate hypertension, who
needed either initiation (untreated patients) or escalation (patients on
monotherapy) of antihypertensive therapy. In usual care, patients
received their doctor's choice of blood pressure-lowering medication.
Among
700 randomized patients (mean age, 56 years; 58% women; 29% had diabetes; mean
baseline systolic/diastolic BP, 154/90 mm Hg), 675 (96%) completed the trial.
In the
study published August 14, 2018 in JAMA, 70% patients in the triple
pill group achieved the BP targets of systolic/diastolic BP of less
than 140/90 mm Hg (or <130/80 mm Hg in patients with diabetes or chronic
kidney disease [CKD]) compared with 55% patients receiving usual care.
The
maximum difference between the two treatment groups was observed at six weeks
after starting treatment, when 68% of those receiving the triple pill had
achieved their target BP vs 44% of those receiving usual care. The average reduction
in blood pressure was 8.7 mm Hg for participants receiving the triple pill and
4.5 mm Hg for those receiving usual care. The benefits of triple pill were
maintained until six months. No significant between-group differences were
observed in the proportion of patient withdrawal from BP-lowering therapy due
to adverse events; 6.6% for triple combination pill vs 6.8% for usual care.
Based
on these findings, the study concluded that use of medication, such as the
‘triple pill’ used in this study, as initial therapy or to replace monotherapy
may be an effective way to improve BP control. It was also safe.
Hypertension
is a common and most important risk factor for cardiovascular disease. The low
and middle income countries, in particular, bear a significantly high global
burden of hypertension, making it a major public health problem these
countries.
There
are several barriers to effective control of high BP, including lack of
adequate resources, limited access to treatment and most importantly, poor
patient compliance to treatment due to the need to take multiple pills daily.
The
triple pill offers a useful strategy to control the high burden of
hypertension, especially in the low and middle income countries. Combining the
anti-hypertensive drugs in a single pill would make it easier both for doctors
to prescribe treatment and more importantly for patients to adhere to the
prescribed treatment.
(Source:
JAMA, ACC)
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA
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