Key result
Single-pill amlodipine, HCTZ, and olmesartan sustainably reduces blood pressure over 24 months in rural Rwanda.
Why the study?
Does a once-daily single-pill combination of amlodipine, hydrochlorothiazide, and olmesartan improve blood pressure control in Black African patients with untreated hypertension in a rural setting?
Cohort (n=57)
Does a once-daily single-pill combination of amlodipine, hydrochlorothiazide, and olmesartan improve blood pressure control in Black African patients with untreated hypertension in a rural setting?
Initial therapy with a once-daily single-pill triple antihypertensive combination is feasible and achieves sustained blood pressure control over 24 months in a rural sub-Saharan African setting.
Supports feasibility in rural SSA but should not yet change practice; leaves open cardiovascular outcomes in randomized trials.
INTRODUCTION: Arterial hypertension is a leading modifiable cardiovascular risk factor. Recent guidelines recommend single-pill, low-dose combinations as initial pharmacological strategy. We investigated the long-term feasibility and sustained effect of such a strategy in a remote rural area of Southern Rwanda, in sub-Saharan Africa. METHODS: Hypertension was diagnosed using three sets of blood pressure measurements obtained according to European Society of Hypertension recommendations using a validated oscillometric device (OMRON M7 IT-HEM-7322-E). Individuals meeting diagnostic criteria were initiated on a single-pill combination of amlodipine, hydrochlorothiazide, and olmesartan. Treatment dosage was reassessed and adjusted as needed at each outpatient clinic visit. RESULTS: Fifty-seven Black African participants with confirmed uncomplicated, untreated hypertension (aged 65 [54-70] years; median and interquartile range) had follow-up data available for up to 24 months after inclusion. Blood pressure <140/90 mm Hg was achieved in 37 (65%) participants after 1 month, 51 (89%) after 3 months, 44 (77%) after 6 months, 43 (75%) after 12 months, and 47 (83%) after 24 months. CONCLUSION: Long-term management of arterial hypertension with a once-daily single-pill combination of amlodipine, hydrochlorothiazide, and olmesartan as initial therapy is feasible in a rural sub-Saharan African setting. Blood pressure reduction is sustained for at least 24 months. Single-pill combinations should be made accessible even in remote areas of low- and middle-income countries.
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Hunjan et al. (2026) conducted a cohort in Arterial hypertension (n=57). Single-pill combination of amlodipine, hydrochlorothiazide, and olmesartan was evaluated on Blood pressure <140/90 mm Hg at 24 months. A once-daily single-pill combination of amlodipine, hydrochlorothiazide, and olmesartan achieved blood pressure <140/90 mm Hg in 83% of participants at 24 months.
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