New research presented at the ESC Congress 2024 highlights the potential of single-pill combinations in managing hypertension and improving patient adherence. Several trials investigated the efficacy and safety of these combinations, along with the impact of medication timing on cardiovascular outcomes.
Simplifying Hypertension Treatment with Combination Pills
One study evaluated a single-pill combination (GMRx2) containing low doses of telmisartan, amlodipine, and indapamide in patients with mild to moderate hypertension. The trial randomized participants to either GMRx2 at 1/4 dose (telmisartan 10 mg/amlodipine 1.25 mg/indapamide 0.625 mg), 1/2 dose (telmisartan 20 mg/amlodipine 2.5 mg/indapamide 1.25 mg), or placebo. Results showed that GMRx2 effectively reduced blood pressure compared to placebo, with good tolerability. According to Principal Investigator Anthony Rodgers, MBChB, MPH, PhD, "GMRx2 reduced BP quickly in mild-to-moderate hypertension and more effectively than dual therapy in a broad, large hypertensive population, without safety concerns."
A related study conducted in Nigeria compared the efficacy and safety of GMRx2 in various doses (one-quarter, one-half, and standard) against standard care in Black African adults with uncontrolled hypertension. The findings indicated that GMRx2's effects in Nigerian patients were consistent with those observed in broader populations, demonstrating excellent effectiveness, even when compared against a standard-care protocol that achieved better results than typically seen in routine practice, according to main investigator Dike Ojji, MD.
Quadruple Combination for Resistant Hypertension
In the QUADRO trial, researchers investigated the addition of isopropol to a combination of three other blood pressure-lowering drugs in a quadruple single-pill combination. The study found that this quadruple combination was more effective at reducing blood pressure than taking the same three drugs in separate pills in patients with resistant hypertension. Investigators noted that individuals with resistant hypertension often require multiple medications, leading to non-adherence. The availability of a quadruple single-pill combination could improve adherence and provide effective blood pressure control in resistant or difficult-to-treat hypertension.
Timing of Medication Intake
Two separate trials, BedMed and BedMed-Frail, examined the impact of morning versus evening administration of blood pressure medications on cardiovascular outcomes. The trials found no significant differences in major cardiovascular events or safety among patients taking blood pressure medications in the morning versus the evening. Principal Investigator Scott Garrison, MD, stated, "We found bedtime vs. morning administration [provided] no difference in MACE, nor in potential hypotensive, visual, cognitive or other safety events in a general population and importantly, in frail older patients, a subgroup who are generally excluded from clinical trials. We can now dismiss the treatment timing as being important and advise patients to take their BP medication when they are least likely to forget."
