Prevention Prize Finalists (039–042)Effects of Low-dose Triple Combination Therapy on Time at Target Blood Pressure – Results From the TRIUMPH Randomized Controlled Trial
Section snippets
Background
Cumulative exposure to hypertension is an adverse prognostic marker. However, longitudinal assessments of blood pressure (BP) control, e.g., TIme at TaRgEt (TITRE), are not routinely assessed. We determined whether low-dose triple combination antihypertensive therapy achieved greater TITRE compared to usual care.
Methods
TRIUMPH (TRIple pill vs Usual care Management for Patients with mild-to-moderate Hypertension) was a randomised controlled trial including 700 patients (age, 56±11 yrs) requiring initiation or escalation of antihypertensive therapy. Patients from hospital clinics in Sri Lanka were randomised to once-daily single pill combination (telmisartan-20mg/amlodipine-2.5mg/chlorthalidone-12.5mg) or standard care. Between-group differences in TITRE were compared over 24wks, with TITRE defined as
Results
Patients allocated the triple pill (n=349) achieved higher TITRE compared to standard care (n=351) over 24wks (64% vs 43%, risk difference 21%, 95%CI 6-26%, p<0.001). Almost twice as many patients on the triple pill spent the majority of time at target (TITRE>50%: 64% vs 37%, p<0.001). The effect of the triple pill was seen early, with most achieving TITRE>50% by 12wks. When predictors of TITRE were examined, only triple pill therapy was predictive of TITRE>50% (OR 3.41; 95%CI, 2.30-5.04,
Conclusions
Among patients with mild-moderate hypertension, treatment with a low-dose triple combination pill substantially increased time at BP target compared to usual care. This study introduces TITRE as a novel longitudinal preventative care outcome in clinical trials.