Triple therapy was associated with the lowest rate of uncontrolled blood pressure (6.2%) compared to monotherapy and maximal polytherapy (both 20%; p=0.042).
Cross-Sectional (n=214)
Does triple therapy improve blood pressure control compared to other treatment strategies in hypertensive patients?
Triple therapy represents an effective strategy for achieving blood pressure control in hypertensive patients, even in those with advanced cardiac remodeling.
Absolute Event Rate: 6.2% vs 20%
p-value: p=0.042
Objective: Therapeutic escalation in arterial hypertension (HTN) is frequently required due to progressive target organ damage and insufficient blood pressure (BP) control with simplified regimens. This study evaluated the comparative efficacy of different antihypertensive strategies and explored the presence of therapeutic inertia in resistant HTN. Design and method: In this cross-sectional study, 214 hypertensive patients (mean age 65.2 ± 11.5 years) were stratified according to treatment regimen: monotherapy (n = 35), dual therapy (n = 51), triple therapy (n = 48), and polytherapy (>3 drug classes, n = 20). BP control (<140/90 mmHg) and echocardiographic parameters — interventricular septum (IVS) thickness, posterior wall (PW) thickness, and left ventricular ejection fraction (LVEF) — were assessed. Group comparisons were performed using ANOVA and chi-square tests. Results: Triple therapy achieved the highest BP control rate, with only 6.2% uncontrolled cases (p=0.042), significantly outperforming both monotherapy and maximal polytherapy (both 20%). Patients who benefitted from treatment intensification were those who presented more advanced structural remodeling, with progressive myocardial wall thickening; a significant increase in PW thickness was observed (p=0.017), reaching peak values in the triple therapy group (11.04 mm). Patients requiring polytherapy were those who exhibited the most adverse clinical profile, including higher mean systolic BP (134.7 mmHg, p=0.046), dyslipidemia (80%), and chronic kidney disease (35%). Furthermore, treatment escalation was guided by clinical criteria rather than age (p=0.80). Therapeutic optimization was implemented in 95.7% of uncontrolled cases, indicating low therapeutic inertia (p<0.001). Conclusions: Triple therapy represents the most effective strategy for BP control in hypertensive patients, even in the presence of advanced cardiac remodeling. While clinical inertia was low in the studied cohort, true resistant HTN remains a major challenge, particularly in patients with a high metabolic and renal burden.
Rodean et al. (2026) conducted a cross-sectional in Arterial hypertension (n=214). Triple therapy vs. Monotherapy and maximal polytherapy was evaluated on Uncontrolled blood pressure (≥140/90 mmHg) (p=0.042). Triple therapy was associated with the lowest rate of uncontrolled blood pressure (6.2%) compared to monotherapy and maximal polytherapy (both 20%; p=0.042).