Low-Dose Triple Pill Reduces Blood Pressure in More People

(The George Institute)

15 August 2018. A clinical trial shows a single medication with low doses of three common drugs reduces high blood pressure in more people with the condition than the normal care. Results of the trial, led by a team at the George Institute for Global Health in Newtown, Australia appear in yesterday’s issue of JAMA (paid subscription required), published by American Medical Association.

Investigators at the George Institute and colleagues in Sri Lanka led by medical researcher Ruth Webster are seeking easier ways for people with high blood pressure to control their condition. World Health Organization says high blood pressure is a global public health crisis, responsible for increases in heart disease, stroke and kidney failure and premature death and disability. WHO estimates 9.4 million people die each year from high blood pressure, and contribute to half (51%) of deaths due to stroke and nearly half (45%) of deaths from heart disease.

While the condition is treatable and manageable, treatment strategies for high blood pressure often impose burdens on patients. Webster explains in an institute statement that, “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.”

The George Institute proposed a simpler treatment they call the Triple Pill. This pill, taken once a day, contains half-doses of three leading blood pressure medications: telmisartan, amlodipine, and chlorthalidone. Telmisartan works by blocking certain proteins that tighten blood vessels allowing for easier blood flow. Amlodipine, known as a calcium channel blocker, relaxes blood vessels reducing strain on the heart. Chlorthalidone helps the kidneys reduce excess water and salt in the blood that contribute to high blood pressure.

The clinical trial tested the Triple Pill among 700 individuals in Sri Lanka with high blood pressure, defined as systolic/diastolic readings of 140/90 or higher. Participants averaged 56 years in age, 58 percent were women, and 29 percent also had diabetes. At the start of the study, the blood pressure of participants was 154/90. Individuals in the study were randomly assigned to receive the Triple Pill or follow their usual treatments for 6 months. Nearly all (96%) of participants completed the study.

The study looked primarily at changes in systolic/diastolic blood pressure readings, particularly the number of participants able to lower their scores below the target of 140/90, or 130/80 if the individual also had diabetes or chronic kidney disease. The results show 7 in 10 (70%) of Triple Pill recipients achieved this goal, compared to just over half (55%) of those receiving the usual care, a large enough difference to be statistically reliable.

About equal percentages of Triple Pill recipients (38%) experienced adverse effects such as muscle pain, dizziness, and fainting, as those receiving the usual care (35%). And about 7 percent of each group had to leave the study because of adverse events.

The George Institute plans to amplify the trial’s results among medical and public health communities, particularly governments and insurance companies, to promote the Triple Pill as a low-cost and effective alternative for controlling high blood pressure.

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