Association of Low-Dose Triple Combination Therapy vs Usual Care With Time at Target Blood Pressure: A Secondary Analysis of the TRIUMPH Randomized Clinical Trial
Gnanenthiran, SR
Wang, N
DiTanna, GL
Salam, A
Webster, R
DeSilva, HA
Guggilla, R
Jan, S
Maulik, PK
Naik, N
Selak, V
Thom, S
Prabhakaran, D
Schutte, AE
Patel, A
Rodgers, A
DeSilva, HA
Guggilla, R
Jan, S
Maulik, PK
Naik, N
Selak, V
Thom, S
Prabhakaran, D
Schutte, AE
Patel, A
Rodgers, A
- Publisher:
- American Medical Association (AMA)
- Publication Type:
- Journal Article
- Citation:
- JAMA Cardiol, 2022, 7, (6), pp. 645-650
- Issue Date:
- 2022-06-01
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Importance Cumulative exposure to high blood pressure BP is an adverse prognostic marker Assessments of BP control over time such as time at target have been developed but assessments of the effects of BP lowering interventions on such measures are lacking Objective To evaluate whether low dose triple combination antihypertensive therapy was associated with greater rates of time at target compared with usual care Design Setting and Participants The Triple Pill vs Usual Care Management for Patients With Mild to Moderate Hypertension TRIUMPH trial was a open label randomized clinical trial of low dose triple BP therapy vs usual care conducted in urban hospital clinics in Sri Lanka from February 2016 to May 2017 Adults with hypertension systolic BP 140 mm Hg and or diastolic BP 90 mm Hg or in patients with diabetes or chronic kidney disease systolic BP 130 mm Hg and or diastolic BP 80 mm Hg requiring initiation untreated patients or escalation patients receiving monotherapy of antihypertensive therapy were included Patients were excluded if they were currently taking 2 or more blood pressure lowering drugs or had severe or uncontrolled blood pressure accelerated hypertension or physician determined need for slower titration of treatment a contraindication to the triple combination pill therapy an unstable medical condition or clinically significant laboratory values deemed by researchers to be unsuitable for the study All 700 individuals in the original trial were included in the secondary analysis This post hoc analysis was conducted from December 2020 to December 2021 Intervention Once daily fixed dose triple combination pill telmisartan 20 mg amlodipine 2 5 mg and chlorthalidone 12 5 mg therapy vs usual care Main Outcomes and Measures Between group differences in time at target were compared over 24 weeks of follow up with time at target defined as percentage of time at target BP Results There were a total of 700 randomized patients mean SD age 56 11 years 403 57 6 women Patients allocated to the triple pill group n 349 had higher time at target compared with those in the usual care group n 351 over 24 weeks follow up 64 vs 43 risk difference 21 95 CI 16 26 P 001 Almost twice as many patients receiving triple pill therapy achieved more than 50 time at target during follow up 64 vs 37 P 001 The association of the triple pill with an increase in time at target was seen early with most patients achieving more than 50 time at target by 12 weeks Those receiving the triple pill achieved a consistently higher time at target at all follow up periods compared with those receiving usual care mean SD 0 6 weeks 36 3 30 9 vs 21 7 28 9 P 001 6 12 weeks 55 2 31 9 vs 33 7 33 0 P 001 12 24 weeks 66 0 31 1 vs 43 5 34 3 P removed
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