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 doctors 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