Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA. https://doi.org/10.1001/jama.2024.18080 Dr. Dike B. Ojji et al.
Points
- The trial assessed the efficacy and safety of a low-dose triple-pill hypertension treatment compared to standard care in 300 Black African adults with untreated or single-medication-controlled hypertension.
- The innovative treatment combined lower doses of telmisartan, amlodipine, and indapamide, compared to the standard-care approach, which began with amlodipine per national guidelines.
- The triple-pill group showed a significantly greater reduction in home systolic blood pressure (31 mm Hg) than the standard care group (26 mm Hg), with a statistically significant adjusted difference of -5.8 mm Hg.
- A higher percentage of patients in the triple-pill group achieved clinic blood pressure targets (82% vs. 72%) and home blood pressure control (62% vs. 28%) than in the standard care group.
- The triple-pill protocol demonstrated superior efficacy without an increase in treatment discontinuations due to adverse events, suggesting good tolerability and a promising strategy for hypertension management in sub-Saharan Africa.
Summary
In this randomized, open-label trial conducted in Nigeria, the efficacy and safety of a low-dose triple-pill hypertension treatment were assessed against the standard-care protocol among 300 Black African adults. These participants, who either had untreated hypertension or were on a single antihypertensive medication, were followed over six months. The innovative triple-pill combined lower doses of telmisartan, amlodipine, and indapamide and was compared to the conventional approach starting with amlodipine based on the national guidelines. The primary aim was to measure home systolic blood pressure reduction and monitor for any treatment discontinuations due to adverse effects.
At six months, the trial reported significant findings. The group receiving the triple-pill protocol experienced a more significant reduction in mean home systolic blood pressure, with an average decrease of 31 mm Hg (95% CI, 28 to 33 mm Hg), compared to a 26 mm Hg (95% CI, 22 to 28 mm Hg) reduction in the standard-care group. The difference in reduction was statistically significant (adjusted difference, -5.8 mm Hg [95% CI, -8.0 to -3.6]; P < .001). Additionally, better blood pressure control was achieved in the triple-pill group, with 82% reaching clinic blood pressure targets compared to 72% in the standard care group. The rate of achieving home blood pressure control was also significantly higher (62% vs 28%).
The study concluded that for Black African adults with uncontrolled hypertension, the low-dose triple-pill protocol not only provided superior blood pressure lowering but also improved overall blood pressure control compared to the standard-care protocol. Importantly, it achieved these outcomes without an increase in treatment discontinuations due to adverse events, indicating good tolerability. This approach presents a promising strategy for managing hypertension effectively in sub-Saharan Africa.
Link to the article: https://jamanetwork.com/journals/jama/fullarticle/2823291
References Ojji, D. B., Salam, A., Sani, M. U., Ogah, O. S., Schutte, A. E., Huffman, M. D., Pant, R., Ghosh, A., Dhurjati, R., Lakshmi, J. K., Ripiye, Nanna. R., Orji, I. A., Kana, S. A., Abdussalam, T., Olawumi, A. L., Alfa, I. M., Orimolade, O. A., Ajayi, M. O., & Rodgers, A. (2024). Low-Dose Triple-Pill vs Standard-Care Protocols for Hypertension Treatment in Nigeria: A Randomized Clinical Trial. JAMA. https://doi.org/10.1001/jama.2024.18080
