Triple superior to dual therapy in achieving BP goal
Adding a third drug to achieve the target blood pressure (BP) seems to be more effective than increasing the dose of existing dual therapy without any increase in adverse events, suggest the results of a meta-analysis, adding that early use of triple therapy can help improve hypertension control.
The investigators searched publication databases, clinical trial registries and regulatory agency websites until April 2018 for double-blind randomized controlled trials (RCTs) comparing triple with dual therapy with BP-lowering drugs among hypertensive patients for at least 3 weeks.
Random effects model was used to conduct meta-analyses for efficacy and safety outcomes. Regimen efficacy was compared with observed efficacy and was predicted using the Therapeutic Intensity Score (TIS) and the Law et al method, which predict dose doubling increases efficacy by 100 percent and around 20 percent, respectively.
A total of 14 RCTs, including 11,457 participants, met the inclusion criteria. Compared with dual therapy, triple therapy lowered BP by 5.4/3.2 mm Hg (p<0.001) and improved BP control by 58 percent (vs 45 percent for dual therapy; relative risk [RR], 1.33, 95 percent CI, 1.25–1.41). Incidence of withdrawals due to adverse events were comparable (3.3 percent vs 3.4 percent; RR, 1.24, 1.00–1.54; p=0.05).
Law et al’s method was superior to TIS in predicting differences in efficacy between the two regimens. Furthermore, adding a third drug achieved on average about a fourfold reduction in BP compared with doubling the dose of dual therapy component drugs (6.0/3.6 vs 1.5/0.8 mm Hg) for patients uncontrolled on submaximal dose dual therapy.
“Most patients with hypertension need at least two drugs to achieve goal blood pressure,” the investigators noted.