In Brief | Cardiovascular Disease
Low-Dose Triple-Pill Shows Promise Over Standard Care for Hypertension Treatment in Nigeria: A Randomized Clinical Trial
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Time to listen: 04:50
Originally Published: 31 August 2024
Sourced: JAMA
Type of article: In Brief
MedED Catalogue Reference: MNC002
Category: Cardiovascular Disease
Cross Reference: Non-communicable Diseases, Gerontology
Keywords: Hypertension, cardiovascular disease, heart failure
A low-dose triple-pill protocol was more effective in lowering and controlling blood pressure compared to the standard-care protocol, without compromising safety, among Black African adults with uncontrolled hypertension.
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Originally published in JAMA 31 August 2024 This summary does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information.
Participants were randomly assigned to one of two treatment protocols:
- Low-dose triple-pill protocol: This involved a combination of telmisartan, amlodipine, and indapamide in varying doses (10/1.25/0.625 mg, 20/2.5/1.25 mg, and 40/5/2.5 mg), with accelerated dose escalation.
- Standard-care protocol: Following Nigeria’s hypertension treatment guidelines, starting with 5 mg of amlodipine.
The primary outcome for effectiveness was the reduction in home mean systolic blood pressure, and the primary safety outcome was discontinuation of treatment due to adverse events, measured over six months.
Of the 300 participants, 273 (91%) completed the trial.
- By month 6, the mean home systolic blood pressure in the triple-pill group had decreased by an average of 31 mm Hg, while the standard-care group saw a reduction of 26 mm Hg (95% CI, 22 to 28 mm Hg), resulting in an adjusted difference of −5.8 mm Hg.
- 82% of the participants in the triple-pill group achieved clinic blood pressure control (<140/90 mm Hg) compared to 72% in the standard care group.
- 62% of those in the triple-pill group achieved home blood pressure control (<130/80 mm Hg) compared to 28% in the standard care group.
- Importantly, no participants discontinued treatment due to adverse events, indicating good tolerability for both protocols.
In conclusion, the low-dose triple-pill protocol was more effective in lowering and controlling blood pressure compared to the standard-care protocol, without compromising safety, among Black African adults with uncontrolled hypertension.
The trial was registered with the Pan African Clinical Trials Registry (PACTR20210757957211)
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, N. 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, e2418080. Advance online publication. https://doi.org/10.1001/jama.2024.18080
Additional references
1. Moloro, A. H., Seid, A. A., & Jaleta, F. Y. (2023). A systematic review and meta-analysis protocol on hypertension prevalence and associated factors among bank workers in Africa. SAGE open medicine, 11, 20503121231172001. https://doi.org/10.1177/20503121231172001
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