A new drug combination has the potential to transform the treatment of hypertension. The upfront use of three low-dose drugs in one pill is as safe and more effective than conventional treatment.
Arterial hypertension remains a global scourge, a source of many cardiovascular and neurological complications, both in rich countries and in the rest of the world.
In a clinical trial conducted by researchers at the George Institute for Global Health, and published in the JAMA, the greater efficacy and safety of a “polypill” (or “triple pill”), combining low doses of three inexpensive (because generic) drugs, has been demonstrated in the treatment of arterial hypertension. The three drugs are: telmisartan (20 milligrams), amlodipine (2.5 milligrams) and chlorthalidone (12.5 milligrams).
A “polypill” trial versus usual treatment
70% of people taking the “polypill” reached the recommended blood pressure goal, compared to just over 50% of those who continued on their conventional treatment for hypertension.
Unlike the treatment chosen by the doctor, the combined pill is able to lower their blood pressure to 140/90 mm Hg or less. The target for people with diabetes or kidney disease is 130/80 mm Hg, numbers that many people taking the “polypill” have been able to achieve. Tolerance was also good with no increase in treatment dropout rates.
The clinical trial testing the efficacy and safety of the “polypill” included 700 people with an average age of 56 and an average blood pressure of 154/90 mm Hg. Participants were drawn at random to receive, either the combined pill or their usual antihypertensive treatment.
A likely change in strategy
Normally, people with high blood pressure begin with a single, low-dose blood pressure medication, chosen according to their risk profile. But they must then return several times to their doctor to most often increase the doses, or even combine other antihypertensive drugs.
This process is long, complicated and expensive, and the fact of initially giving a single drug in high doses not only leads to a greater risk of side effects, but after a certain time triggers a reaction of the body to this drug. which reduces its effectiveness. This is called the phenomenon of “counter-regulations”, and it forces doctors to add other anti-hypertensives with a mechanism of action aimed at limiting these reactions which reduce the effectiveness of the treatment.
An app for hypertensives around the world
According to study co-author Dr Ruth Webster: “The problem with this approach” [par étape] is that “it’s not only inefficient, it’s also time-consuming and expensive. Plus, we also know that a lot of doctors and patients find it too complicated and therefore don’t follow the process.” The George Institute researchers therefore believe that their “polypill” could really make a difference in the current treatment of hypertension.
“This study has global relevance,” says Professor Patel, also a co-author of the study. “While low- and middle-income countries are most logically interested in terms of cost-effectiveness, these benefits are just as important in a high-income country like Australia.”
Hypertension is a scourge, even in developed countries
High blood pressure is the leading cause of death and cardiovascular disease worldwide. It can also be responsible for vascular dementia. However, significant gaps remain in the treatment of people with high blood pressure.
In low- and middle-income countries, drug availability and cost is a critical issue and only one-third of people with hypertension in these countries receive treatment. Moreover, only half of patients treated in high-income countries and a quarter in low- and middle-income countries achieve effective blood pressure control. The use of monotherapy (treatment with a single antihypertensive), the efficacy of which is modest, is mainly responsible for this failure.
Furthermore, recent international guidelines for hypertension provide lower blood pressure goals in high-risk patients, increasing the need for more effective treatment strategies.
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