TRIUMPH: Low-Dose Combination Pill Lowers Blood Pressure More Than Usual Care

Patients who take a combination pill of three blood pressure-lowering medications may be more likely to reach target blood pressure than patients receiving usual care, according to results from the TRIUMPH trial presented by Ruth Webster, PhD, in a Late-Breaking Clinical Trial session on Monday, March 12 at ACC.18 in Orlando, FL.

Conducted in Sri Lanka, the TRIUMPH trial enrolled 700 patients with an average age of 56. At the time of enrollment, average blood pressure was 154/90 mm Hg, and 59 percent of participants were not receiving high blood pressure treatment. Patients were randomly assigned to receive either usual care in which their physician selected their medication or the combination “Triple Pill,” consisting of telmisartan (20 mg), amlodipine (2.5 mg) and chlorthalidone (12.5 mg). The primary endpoint was the proportion of patients who achieved a blood pressure of 140/90 mm Hg or less at six months.

After six weeks, 68 percent of those taking the Triple Pill had achieved blood pressure within their target range, compared with 44 percent of those in the usual-care group. For patients receiving the Triple Pill, the average blood pressure reduction was 8.7 mm Hg, compared with 4.5 mm Hg for those receiving usual care. After six months, 83 percent of participants in the Triple Pill group were still taking the combination pill, while one-third of patients in the usual-care group were taking at least two blood pressure-lowering drugs.

TRIUMPH is the first large-scale study to test the theory that low doses of three medications could achieve better blood pressure control. The researchers now are conducting a cost-effectiveness evaluation, according to Webster, who noted the need for cost-effective treatments in many parts of the world. “The most urgent need for innovative strategies to control blood pressure is in low- and middle-income countries,” Webster said. “The Triple Pill approach is an opportunity to ‘leap frog’ over traditional approaches to care and adopt an innovative approach that has been shown to be effective.”

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Novel Agents, Statins, Hypertension

Keywords: ACC18, ACC Annual Scientific Session, Primary Prevention, Blood Pressure, Chlorthalidone, Public Health, Random Allocation, Amlodipine, Benzoates, Benzimidazoles, Drug Combinations, Hypertension, Diabetes Mellitus, Lipoatrophic, Renal Insufficiency, Chronic

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