3-in-1 pill

21 August 2018

A new pill which combines three blood pressure drugs could be far more effective than existing treatments, scientists have found.

It offers hope for hundreds of thousands of people in the UK who take daily tablets for the condition.

Currently only half of people on blood pressure medication get their levels down to a healthy target. 

However, the triple combination pill saw the success rate rise to 70 per cent within six months.

Patients were given the triple pill in a trial – combining common blood pressure drugs telmisartan, amlodipine and chlorthalidone. 

Dr Ruth Webster, who led the research, said: ‘Our results could help millions of people globally reduce their blood pressure and reduce their risk of heart attack or stroke.’

Her team found combining the three treatments at half the normal dose was not only effective, but was as safe as giving drugs separately. 

Traditionally patients begin treatment with one drug at a low dose, which is increased over time with additional drugs added and increased in dosage to try to push down blood pressure.

That involves a lot of trial and error and many repeat appointments. A high number of patients just give up on the pills.

Dr Webster said: ‘Patients are brought back at frequent intervals to see if they are meeting 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. This new approach is much simpler and it works.’ 

High blood pressure – also known as ‘hypertension’ – affects one in three adults, more than 17 million of the British population.

It vastly increases the risk of heart attacks, strokes and vascular dementia, but because it has no symptoms until it is too late, only half of people even know they are at risk. 

Of those who have been diagnosed, hundreds of thousands take daily one-drug pills. But the pills only reduce blood pressure to a healthy level in half of patients.

The new approach, pioneered by the George Institute for Global Health in Australia, could see that transformed. 

NHS watchdog NICE is currently reviewing blood pressure guidelines with a view to cutting rates of heart disease.

It is considering lowering the threshold for prescribing medication, which could mean millions more Britons are offered drugs.

The trial, which was conducted in Sri Lanka, involved 700 patients with an average age of 56 and blood pressure of 154/90. The study was published in JAMA medical journal.

Half were given the triple pill. The other half were given a single medication of their doctor’s choice.

Some 70 per cent of patients on the triple pill reached their target blood pressure of 140/90. On average they went far lower, achieving 125/76 after six months.

Of those on normal treatments, only 55 per cent reached the target and the average after six months was just 134/81.

Graham MacGregor, Professor of Cardiovascular Medicine at Queen Mary University of London and Chairman of Blood Pressure UK, said “A recent study published in the Journal of American Medical Association has clearly demonstrated that a fixed low dose triple combination of three different drugs that are all additive at lower dose was more effective than usual care for the control of blood pressure.

The study appears to have been well done and convincingly demonstrates that it is better to start with three different drugs combined together in low dose than giving the usual dose of other drugs in a step wise increase.  Furthermore, with the low dose triple combination there were no more side effects or withdrawal from treatment in the group given three different triple dose combination.  The study strongly suggests that we should now move to using these combination tablets in the treatment of high blood pressure. 

However, the problem, particularly in the UK, is that whilst all of these drugs individually are off patent and are cheap there are only a few combination tablets available and nearly all still on patent.  What is needed, therefore, is a generic combination tablet which would mean that we could then treat people with high blood pressure more effectively at a low cost”.