MedicalResearch.com Interview with:
Dr Ruth Webster PhD, BMedSc(hons), MBBS(hons), MIPH(hons)
Head, Research Programs, Office of the Chief Scientist
Senior Lecturer, Faculty of Medicine
The George Institute for Global Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We know from previous research that 80% of the blood pressure lowering efficacy of any medication occurs in the first half of the dose whilst most side effects occur at higher doses. We also know that most people will require at least 2 blood pressure lowering medications to reach their target blood pressure and that combining multiple pills into one combination medication helps patients take their medication more reliably. There was therefore good evidence to believe that using three half strength doses in one pill would be better than usual care in helping patients to achieve their blood pressure targets.
We showed that, compared with patients receiving usual care, a significantly higher proportion of patients receiving the Triple Pill achieved their target blood pressure of 140/90 or less (with lower targets of 130/80 for patients with diabetes or chronic kidney disease).
It’s estimated more than a billion people globally suffer from high blood pressure with the vast majority having poorly controlled blood pressure. Our results could help millions of people globally reduce their blood pressure and reduce their risk of heart attack or stroke.
MedicalResearch.com: What should readers take away from your report?
Response: Traditionally patients begin treatment with one drug at a very low dose, which is increased over time with additional drugs added and increased in dosage to try to reach target. Patients are brought back at frequent intervals to see if they are meeting their targets with multiple visits required to tailor their treatments and dosage. This is not only time inefficient, it’s costly. We also know that many doctors and patients find it too complicated and often don’t stick to the process. Additionally, 80% of the effectiveness of any blood pressure lowering drug occurs in the first half dose with side effects predominantly occurring at higher doses. In this context, our study has shown it makes sense to use lower doses of multiple drugs rather than higher doses of fewer drugs.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The George Institute is now looking at strategies to maximise uptake of the study results. This includes examining the acceptability of the Triple Pill approach to patients and their doctors, as well as cost-effectiveness which will be important for governments and other payers to consider.
Webster R, Salam A, de Silva HA, et al. Fixed Low-Dose Triple Combination Antihypertensive Medication vs Usual Care for Blood Pressure Control in Patients With Mild to Moderate Hypertension in Sri Lanka A Randomized Clinical Trial. JAMA. 2018;320(6):566–579. doi:10.1001/jama.2018.10359
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