An innovative 3 in 1 pill for blood pressure has proven more effective than standard care, according to a new trial, and could transform the way we manage hypertension.
Lead researcher of the study, Dr Ruth Webster from The George Institute for Global Health, told doctorportal that “our results could help millions of people globally reduce their blood pressure more effectively and reduce their risk of heart attack or stroke.”
The randomised trial, published in JAMA, was conducted in Sri Lanka and enrolled 700 patients with hypertension. Patients either received usual care or a once-daily dose of a triple combination pill, with each drug (telmisartan, amlodipine and chlorthalidone) at a half dose.
The researchers found that treatment with the triple pill led to an increased proportion of patients achieving their target blood pressure compared with usual care. They concluded that the use of this medication as initial therapy, or as replacement for monotherapy, may be an effective way to improve blood pressure control.
Current hypertension management approach not ideal
Professor Garry Jennings, Chief Medical Advisor at the Heart Foundation, told doctorportal that the results of the trial offer a different strategy for managing blood pressure.
“We know we don’t manage high blood pressure that well with present methods, and a lot of the failure is related to adherence to therapy – 3 pills in 1 is a proven way of helping with adherence.”
“What is interesting in this study is that you don’t need the full doses of each medication, and this seems to get some pretty good outcomes.”
Dr Webster said that the current approach for managing high blood pressure – starting one drug at a low dose, and then increasing the dose and adding more drugs – is not ideal.
“Patients are brought back at frequent intervals to see if they are meeting their targets with multiple visits required to tailor their treatments and dosage. This is not only time inefficient, it’s costly.”
“We also know that many doctors and patients find it too complicated and often don’t stick to the process.”
New approach could see better effectiveness
Dr Webster also noted that around 80% of the effectiveness of any blood pressure medication occurs in the first half dose, with side effects mainly occurring at higher doses. As a result, it makes sense to offer patients lower doses of multiple drugs, rather than higher doses of fewer drugs.
She said the George Institute is now looking at strategies to maximise the uptake of the study results.
“This includes examining the acceptability of the triple pill approach to patients and their doctors, as well as cost-effectiveness, which will be important for governments and other payers to consider.”
“We will also look to influence guidelines for the management of hypertension to include the recommendation to start with multiple, low dose blood pressure lowering medications.”
Professor Jennings added that the triple pill would be fairly cheap and therefore suitable for use across the world.
“High blood pressure is the biggest global risk factor for death and disability, so having something that is suitable for use in every scenario is an important development.”
Change unlikely in the near future
However, Professor Jennings said that given hypertension guidelines in Australia have only recently been updated, it is unlikely that they will be significantly overhauled in the near future.
“At this stage, the preparation is not approved for prescription anyway, so there’s a few steps to go through.”
“While this a successful trial, it’s always hard to replicate trial results in the community.”
He also said that hypertension was a complex issue that Australia, and the whole world, is trying to tackle.
“There’s inherently problems in managing a condition which is lifelong, has no symptoms, and where knowledge about the reasons people are having their blood pressure managed is fairly low.”