3-in-1 pill improves chance of lowering blood pressure

If lowering your blood pressure to a more normal range has been difficult, there may help on the horizon. A new study finds a “triple pill” or 3-in-1 medication containing low doses of three drugs – telmisartan, amlodipine, and chlorthalidone – appears promising in lowering high blood pressure.

Presented at the annual meeting of the American College of Cardiology, the findings, which are considered preliminary, show this new method of using blood pressure lowering drugs to be more effective than and just as safe as current approaches. 

The study named the Triumph trial and conducted in Sri Lanka, enrolled 700 people with an average age of 56 and all with high blood pressure. Patients were randomly assigned to receive either the combination or Triple pill consisting of the three blood pressure medications combined or their usual blood pressure medication and were followed over the next 6 months. 

The three drugs combined together in the Triple pill work by using different mechanisms to reduce blood pressure by relaxing the blood vessels so the heart does not need to pump as hard to send blood throughout the body.

At the end of the study, 70 percent of participants assigned to the Triple pill had achieved their blood pressure targets, compared with 55 percent of those using whatever blood pressure medication their doctor had prescribed.  The average reduction in blood pressure was 8.7 mm Hg for those receiving the Triple pill and 4.5 mm Hg for those receiving usual care. The benefits from this medication managed to be maintained for at least six months with the researchers concluding this drug was more effective than and just as safe as current approaches.

Even though there is a wide availability of effective blood pressure-lowering drugs, high blood pressure remains a major problem around the world. High blood pressure can lead to increasing risk of heart attacks, strokes, and kidney problems.  Around the world, there are many people who receive no treatment and only about a third of those treated achieve the recommended reduction in blood pressure.

It is not unusual to that in order to achieve desired reductions in blood pressure that more than one medication may be used.  However, this means can often complicate treatment and for some patients, they may find it difficult to adhere to regimens that involve taking multiple pills a day.

The unique factor involving this study was that it is the first large trial designed to test the theory that starting an individual with low doses of three drugs could achieve better blood pressure control compared with usual care.  By combining multiple drugs in a single pill, this makes it easier both for the doctor but more importantly, for the patient to adhere to.

Each of the drugs used in the Triple pill represents a different class of blood pressure medication of which previous studies have shown combining the drugs results in synergistic effects. 

The Triple pill appears to be an approach providing an opportunity to bypass the traditional approaches and to adopt an innovative approach that has been shown to be effective.  Currently, most hypertension guidelines do not recommend combination blood pressure-lowering therapy for initial treatment in people.  But these findings may prompt reconsideration of recommendations in the use of combination therapy.