Three dual combinations of hypertension medications in one polypill – amlodipine and perindopril; perindopril and indapamide; or amlodipine and indapamide – were equally effective in reducing blood pressure (BP) in Indian adults to 140/90 mmHg or less, based on findings from the TOPSPIN trial presented at AHA 2024.

Researchers randomized 1,981 adults with high BP, ages 30 to 79 (median age 52), 42% women, at 35 hospitals in India to receive a single pill that included either amlodipine and perindopril, perindopril and indapamide, or amlodipine and indapamide. Ambulatory BP was measured at enrollment and again at two, four and six months. At the time of enrollment, 55% of the participants were already taking some kind of BP-lowering medication, 18.6% had type 2 diabetes and 6.2% were current smokers.

After six months, results showed that all three combinations of the medications lowered BP equally, roughly 14/8 mmHg lower when measured using 24-hour ambulatory BP monitors and 30/14 mmHg lower when measured in a clinic. Approximately 70% of study participants achieved BP below 140/90 mmHg and more than 40% achieved a stricter BP target of 130/80 mmHg.

According to researchers, each of the three combination pills had an excellent safety profile. Fewer than 3% of all study participants reported ending treatment due to adverse effects from the medications. Additionally, participants in the amlodipine-perindopril combination group also experienced a decrease in fasting blood sugar levels after six months.

"It was reassuring to find that all three dual combinations of commonly recommended [BP] medications were equally effective," said lead study author Dorairaj Prabhakaran, MD, DM, MSc. "This is contrary to the findings observed in the CREOLE study that examined the impact of a similar group of three high [BP] combination pills in Black adults with hypertension in Sub-Saharan Africa and found amlodipine-based combinations to be superior."

Prabhakaran also noted that the study findings have significant meaning outside of India, highlighting that South Asians account for one-fourth of the world's population, with more than five million South Asians living in the U.S. alone.