Low-dose triple single-pill combination therapy significantly increased the rate of achieving blood pressure <140/90 mmHg at 4 to 6 weeks (RR 1.56) compared to standard care, monotherapy, or placebo.
Meta-Analysis (n=1,709)
Does low-dose triple single-pill combination therapy improve blood pressure control compared to standard care, monotherapy, or placebo in patients with hypertension?
Low-dose triple single-pill combinations significantly improve blood pressure control in hypertension but are associated with an increased risk of hypokalemia.
Effect estimate: RR 1.56 (95% CI 1.41-1.72)
Absolute Event Rate: 66.1% vs 42%
p-value: p=<0.01
Recently, Low-dose triple single-pill combinations (LDTC) have become a promising option for managing hypertension. This review evaluates LDTC's effectiveness and safety versus standard care, monotherapy, and placebo for blood pressure (BP) control. A systematic review and meta-analysis of randomized controlled trials retrieved from PubMed, EMBASE, WOS, Scopus, and Cochrane from inception to September 2024. The analysis presented risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). PROSPERO ID: CRD42024595331. We identified five eligible trials with a total of 1,709 patients. LDTC had a higher rate of achieving BP < 140/90 at 4 to 6 weeks (wk) (RR: 1.56; CI: 1.41, 1.72; p < 0.01) and at 8 to 12 wk (RR: 1.43; CI: 1.31, 1.57; P < 0.01). Additionally, LDTC significantly reduced the automated office systolic BP at 4 to 6 wk (MD: -8.80; CI: -10.16, -7.44; p < 0.01), 8 to 12 wk (MD: -8.30; CI: -11.18, -5.42; P < 0.01), and at 24 wk (MD: -6.94; CI: -10.56, -3.32; P < 0.01). However, LDTC indicated an increased rate of hypokalemia (RR: 2.25; CI: 1.50, 3.38; P < 0.01), with no difference between both groups in total adverse events (AEs) (P = 0.44), serious AEs (P = 0.79), treatment discontinuation due to AEs (P = 0.91), and the AEs of special interest (P = 0.54). LDTC therapy is effective and safe for hypertension management but poses potassium depletion. Further large-scale studies are essential to confirm its clinical benefits.
Elgendy et al. (Thu,) conducted a meta-analysis in Hypertension (n=1,709). Low-dose triple single-pill combination (LDTC) vs. Standard care, monotherapy, or placebo was evaluated on Achieving automated office blood pressure target of <140/90 mmHg at 4 to 6 weeks (RR 1.56, 95% CI 1.41-1.72, p=<0.01). Low-dose triple single-pill combination therapy significantly increased the rate of achieving blood pressure <140/90 mmHg at 4 to 6 weeks (RR 1.56) compared to standard care, monotherapy, or placebo.