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A fixed-dose triple combination antihypertensive pill is more effective at controlling blood pressure than usual care, the results of a randomised trial in Sri Lanka show[1]
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The study involved 700 patients with mild-to-moderate hypertension who required escalation (if they were already receiving monotherapy) or initiation of antihypertensive treatment. They were randomly assigned to a once-daily fixed-dose pill containing telmisartan 20mg, amlodipine 2.5mg and chlorthalidone 12.5mg, or usual care.
At six months, 70% of those assigned to the combination pill had achieved the target blood pressure, compared with 55% among those assigned to usual care. The mean blood pressure was 125/76mmHg and 134/81mmHg in each group, respectively.
The researchers explained that hypertension is undertreated in low- and middle-income countries, which is partly a result of affordability and accessibility. A fixed-dose pill could help address these issues.
The findings also lend support to the use of combination therapy in high-income countries, like the UK, which also struggle to achieve blood pressure targets.
“Use of such medication as initial therapy or to replace monotherapy may be an effective way to improve blood pressure control,” the authors concluded in the Journal of the American Medical Association.
References
[1] 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. doi: 10.1001/jama.2018.10359
