ADA Position Statement on Diabetes, Hypertension
October 13, 2017
Twitter alert: What are the risks when researchers post their data prior to peer review?
Key clinical point: Starting hypertensive patients on a single, triple-drug pill produced excellent control.
Major finding: After 6 months, 70% of patients on the triple-drug pill reached target blood pressure, compared with 55% of control patients.
Study details: TRIUMPH, a multicenter, randomized trial with 700 hypertensive adults.
Disclosures: TRIUMPH received no commercial funding. Dr. Webster had no disclosures. Dr. Watson has been a consultant to Amgen, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, and GlaxoSmithKline. Dr. White has been a consultant to Novartis.
Source: Webster R et al. ACC 18 late breaker.
The TRIUMPH results showed the feasibility and efficacy of achieving good blood pressure control with a single pill containing low doses of three different antihypertensive drugs that are well tolerated and have different mechanisms of action. This strategy avoids the adverse effects from drugs used at their maximum dose.
An attraction of this strategy is how seamless it is for patients. They take a single pill with three drugs, which can enhance compliance and in routine practice can reduce their copay. It’s much easier for patients to take a single pill.
, is a research professor of medicine and director of the Clinical Trials Program at the University of Florida in Gainesville. She had no relevant disclosures. She made these comments in an interview.
ORLANDO – Hypertensive adults started on a triple-drug, single daily pill regimen as either initial or early treatment had a sharply better rate of reaching their goal blood pressure after 6 months, compared with usual-care controls, in a multicenter, randomized trial with 700 patients.
“Early use of a low-dose, three-in-one blood pressure lowering pill is safe and provides faster and better control of blood pressure compared with usual care,”, said at the annual meeting of the American College of Cardiology.
The tested polypill contained half the standard doses of the angiotensin receptor blocker telmisartan (20 mg), the calcium channel blocker amlodipine (2.5 mg), and the diuretic chlorthalidone (12.5 mg). After 6 months on this regimen, 70% of patients were at their goal blood pressure, compared with 55% of the control patients, and patients on the polypill had on average a 10/5 mm Hg greater reduction in their blood pressure than did patients on usual care, reported Dr. Webster, head of research programs at the George Institute for Global Health in Sydney. Rates of total and serious adverse events and withdrawals because of adverse events were similar in the two study arms, and both arms also had nearly identical levels of treatment adherence, about 95%.
“No prior trial has evaluated a triple, low-dose pill for initial or early treatment,” she noted.
“This is a home run,” said, professor of medicine and director of the Women’s Cardiovascular Health Center at the University of California, Los Angeles. “In the past, clinicians were told to pick one drug and push it as hard as you could and then maybe think about adding a second drug. Experience has shown that this does not increase efficacy, but it does increase adverse events, so current guidelines say start with two drugs. Now they are showing for the first time that you should start with three drugs. That goes with what we know.”
“Triple-drug therapy for the masses makes complete sense,” especially now that the blood pressure goal for most patients is less than 130/80 mm Hg, said, professor of medicine and chief of hypertension and clinical pharmacology at the University of Connecticut in Farmington. Plus, “compliance is vastly improved when you use a combination-drug pill,” he noted.
The blood pressure targets that Dr. Webster and her associates used were less than 140/90 mm Hg except in patients with diabetes or chronic kidney disease, who had a target of less than 130/80 mm Hg. At the time researchers designed the trial the generally accepted blood pressure target for antihypertensive treatment was less than 140/90 mm Hg, Dr. Webster noted.
October 13, 2017