People taking one blood pressure medication may reach their blood pressure goals more effectively if they instead take lower doses of three medications.
That’s according to a new study in Journal of the American Medical Association (JAMA).
The research raises new questions about what type of drug therapy is best for people with mild to moderate hypertension.
“Our study showed that you get better, faster blood pressure control by using multiple blood pressure drugs at lower doses rather than fewer blood pressure drugs at higher doses,” Ruth Webster, PhD, a researcher from the University of New South Wales in Australia, told Healthline.
The researchers conducted a randomized clinical trial that included 700 patients in Sri Lanka with mild to moderate high blood pressure.
Participants were either not taking medication or were taking a single medication daily when the study began.
Webster put the participants into two groups.
One group received their usual care (a single medication or no treatment) and another group was put on a medication that was a combination of three drugs.
The combination medication included 20 milligrams (mg) of telmisartan, 2.5 mg of amlodipine, and 12.5 mg of chlorthalidone.
Of the participants, 67 percent of those on the combination medication achieved their blood pressure goal six weeks after beginning the therapy, while 43 percent of those in the other group met their goals.
After six months, 69 percent of participants in the combination pill group achieved their blood pressure target compared to 55 percent in the usual care group.
The combination pill was similarly effective across all groups of patients, Webster noted.
Combination drug therapy
In an accompanying editorial, Dr. Mark D. Huffman, Dr. Gbenga Ogedegbe, and Dr. Marc Jaffe noted that triple-drug therapy has been used before in patients who have difficult-to-control hypertension.
This study was different because it looked at those with mild to moderate hypertension.
The doses of each of the medications in the combination pill were all half strength, Webster noted.
“We know that around 80 percent of the efficacy of a blood pressure medication is in the first half of the dose, and we also know that most people will require at least two blood pressure–lowering medications to reach their target blood pressure,” Webster said.
Combination medications are already available on the market and typically are only recommended for people who have uncontrolled blood pressure and take maximum doses of two medications.
“The actual medication components used are not as critical as the choice to use three at half strength to get better blood pressure reduction earlier in the treatment of high blood pressure,” Webster said.
Dr. Michael Miller, a cardiologist from the University of Maryland School of Medicine who isn’t affiliated with the research, said the Food and Drug Administration (FDA) hasn’t been fond of approving a three-in-one pill due to side effects and drug interactions.
That could change, however.
“Good blood pressure control is essential to reduce the risk of stroke, heart, and kidney disease,” Miller told Healthline.
Lifestyle interventions also need to be implemented. These include restricting sodium intake to less than 3/4 teaspoon of salt per day.
“If more than one medication is needed to effectively control blood pressure, patients should discuss with their healthcare providers whether a combination approach may be most suitable for them,” Miller said.
People taking blood pressure medication or medications should talk to their doctors before changing their regimen.
If there hasn’t been a response to monotherapy with a blood pressure–lowering drug, especially with raising at least one dose, it could warrant a change in class or combination, said Dr. Regina S. Druz, a cardiologist from New York.
“Lifestyle modification should always be emphasized,” she told Healthline. “After all, it’s not the magic of pills that makes us better, but we make ourselves better by taking charge of our health.”
A global issue
Although the study was conducted in a middle-income country, it has global relevance because hypertension is a common health issue.
In the United States and Australia, patients are still only achieving control rates of 40 to 50 percent, Webster said.
Her institute is now looking at strategies to maximize study results.
This includes looking at the acceptability of the combination pill approach with patients and physicians as well as assessing cost-effectiveness of combination therapy.