Hypertension is the most common of all the conditions of the circulatory system. Furthermore, the number of Americans at risk for heart attacks and strokes has recently increased.
An estimated 103 million adults have high blood pressure, nearly half of all adults in the United States. In 2009, Americans visited their healthcare providers more than 55 million times to treat high blood pressure.
In 2014, high blood pressure was a primary or contributing cause of death for more than 410,000 Americans. Worldwide, about 9 million people die every year due to cardiovascular complications resulting from high blood pressure.
About 7 in 10 U.S. adults with high blood pressure use medications to treat the condition, but only about half (54 percent) of people with high blood pressure have their condition under control. Achieving desired reductions in blood pressure often requires treatment with more than one medication, which increases the complexity of treatment for patients who may have difficulty adhering to regimens that involve taking multiple pills every day.
However, a new treatment that combines low doses of three blood pressure-lowering medications shows promise for lowering high blood pressure more than usual care.
Conducted in Sri Lanka, the TRIple Pill vs. Usual care Management for Patients with mild-to-moderate Hypertension (TRIUMPH) study enrolled 700 patients with an average age of 56. At the time of enrollment, average blood pressure was 154/90 mm Hg, and 59 percent of participants were not receiving high blood pressure treatment.
Patients were randomly assigned to receive either usual care in which their physicians selected their medication or the combination “Triple Pill,” consisting of telmisartan (20 mg), amlodipine (2.5 mg) and chlorthalidone (12.5 mg). The primary endpoint was the proportion of patients who achieved a blood pressure of 140/90 mm Hg or less at six months.
After six weeks, 68 percent of those taking the Triple Pill had achieved blood pressure within their target range, compared with 44 percent of those in the usual-care group. For patients receiving the Triple Pill, the average blood pressure reduction was 8.7 mm Hg, compared with 4.5 mm Hg for those receiving usual care.
After six months, 83 percent of participants in the Triple Pill group were still taking the combination pill, while one-third of patients in the usual-care group were taking at least two blood pressure-lowering drugs.
This study was the first large trial designed to test the theory that starting treatment with low doses of three drugs could achieve better blood pressure control compared with usual care, and that combining these drugs in a single pill would make it easier both for doctors to prescribe treatment and for patients to adhere to treatment. Rates of participants having to change treatment due to side effects were not significantly different in the two groups (6.6 percent for the Triple Pill, 6.8 percent for usual care).
Recommended targets for blood pressure control varies worldwide. In the U.S., 2017 guidance recommends initiating treatment if blood pressure exceeds 130/80 mm Hg, whereas European guidelines recommend that treatment if blood pressure exceeds 140/90 mm Hg.
Each of the drugs used in the Triple Pill has been shown to be highly effective in reducing blood pressure and preventing deaths and illness due to heart disease and strokes.
The researchers are now conducting a follow-up qualitative study to determine what participants and their physicians thought about using the Triple Pill. They are also conducting a cost effectiveness evaluation to determine whether the "Triple" is a cost-effective solution for blood pressure control.
