Efficacy and Safety of a Novel Triple Single-Pill For Uncontrolled Hypertension: the OPTION TREAT Trial

Novel single-pill combinations with blood pressure (BP)-lowering agents are needed to increase treatment options for hypertension. To assess the efficacy and safety of a novel single-pill (candesartan cilexetil, amlodipine, and chlorthalidone) compared with an active control (valsartan, amlodipine, and hydrochlorothiazide) for uncontrolled hypertension. OPTION TREAT was a randomized, double-blind, double-dummy, noninferiority trial conducted across 19 sites in Brazil. Participants with an office systolic BP of 140-180 mmHg and a diastolic BP of 90-110 mmHg despite dual therapy were randomized in a 1:1 ratio to receive either the experimental treatment or the active control for 12 weeks. The primary outcome was the mean change in office systolic BP from baseline to week 12. Prespecified noninferiority margin was 3 mmHg. Secondary outcomes included mean changes in diastolic BP and adverse events. Overall, 703 participants were included (mean age 57.8 years, 62.7% women, baseline office BP of 153.0/95.6 mmHg). At 12 weeks, the least square mean change in systolic BP was -22.6 mmHg in the experimental group versus -18.2 mmHg in the control group (between-group difference -4.4 mmHg; 90% CI -6.3 to -2.5; p < 0.001). Diastolic was also reduced in both groups, with greater reductions in the experimental group (-13.8 mmHg vs. -12.0 mmHg; p = 0.008). Adherence was high and serious adverse events were rare. In patients with uncontrolled hypertension, a novel triple single-pill containing candesartan cilexetil, amlodipine, and chlorthalidone improved BP control at 12 weeks and had a reasonable safety profile. (Efficacy and Safety of a Novel Triple Single-Pill Combination Therapy Compared with an Active Control in Patients with Uncontrolled Hypertension [OPTION TREAT]: NCT05920005).