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Triple-Combination therapy with olmesartan, amlodipine, and hydrochlorothiazide in black and non-black study
Steven G Chrysant1, Thomas Littlejohn, Joseph L Izzo
1Oklahoma Cardiovascular and Hypertension Center and University of Oklahoma College of Medicine, Oklahoma City, OK, USA. schrysant@yahoo.com
Insights
Triple-combination therapy for hypertension significantly reduced blood pressure (BP) in both Black and non-Black patients compared to dual-combination treatments. This approach improved BP control regardless of race, showing similar efficacy and safety profiles.
Area of Science:
- Cardiovascular Medicine
- Clinical Pharmacology
- Hypertension Research
Background:
- Hypertension awareness has grown, yet blood pressure (BP) control remains a challenge, particularly in Black patients.
- The TRINITY study investigated the efficacy and safety of triple-combination antihypertensive therapy.
- ClinicalTrials.gov identifier: NCT00649389.
Purpose of the Study:
- To evaluate the efficacy and safety of a triple-combination treatment (olmesartan medoxomil/amlodipine besylate/hydrochlorothiazide) versus dual-combination treatments.
- To compare treatment outcomes in Black and non-Black participants within the TRINITY study subgroup.
- To assess BP goal attainment and safety profiles across different treatment regimens.
Main Methods:
- A 12-week, randomized, double-blind, parallel-group study involving 2492 participants with elevated BP.
- Participants received either dual-combination therapy or placebo initially, with subsequent randomization to dual- or triple-combination therapy.
- Interventions included olmesartan medoxomil 40 mg/amlodipine besylate 10 mg/hydrochlorothiazide 25 mg, or component dual-combination treatments.
Main Results:
- Triple-combination therapy demonstrated significant mean reductions in seated diastolic BP (SeDBP) and seated systolic BP (SeSBP) in both Black and non-Black participants (p ≤ 0.0001 vs. dual-combination).
- A higher proportion of participants achieved their BP goal with triple-combination treatment compared to dual-combination treatments, irrespective of race.
- Adverse events were predominantly mild to moderate, with no new safety concerns identified.
Conclusions:
- Triple-combination antihypertensive therapy offers superior BP reduction compared to dual-combination therapies.
- The enhanced efficacy of triple-combination treatment is consistent across racial groups, including Black and non-Black patients.
- This treatment strategy provides a safe and effective option for achieving BP control.
Background:
Although awareness of hypertension in Black patients has increased, blood pressure (BP) is frequently inadequately controlled.
Objective:
This prespecified subgroup analysis of the TRINITY study evaluated the efficacy and safety of olmesartan medoxomil (OM) 40 mg, amlodipine besylate (AML) 10 mg, and hydrochlorothiazide (HCTZ) 25 mg triple-combination treatment compared with the component dual-combination treatments in Black and non-Black study participants.
Study Design:
TRINITY was a 12-week, randomized, double-blind, parallel-group evaluation. The first patient was enrolled in May 2008 and the last patient completed the study in February 2009. The study consisted of a 3-week washout period for participants receiving antihypertensive therapy and a 12-week double-blind treatment period. For the treatment phase, all study participants were stratified by age, race, and diabetes mellitus status and randomized to a treatment sequence that led to their final treatment assignment, which they received from weeks 4 to 12 (OM 40 mg/AML 10 mg/HCTZ 25 mg, OM 40 mg/AML 10 mg, OM 40 mg/HCTZ 25 mg, or AML 10 mg/HCTZ 25 mg). In the first 2 weeks of the double-blind treatment period, all participants received either dual-combination treatment or placebo. Participants assigned to dual-combination treatment continued treatment until week 4, and participants receiving placebo were switched at week 2 to receive one of the dual-combination treatments until week 4. At week 4, participants either continued dual-combination treatment or randomly received triple-combination treatment until week 12.
Setting:
317 clinical sites in the USA and Puerto Rico were included in the study.
Patients:
Study participants eligible for randomization (N = 2492) were ≥18 years of age with mean seated blood pressure (SeBP) ≥140/100 mmHg or ≥160/90 mmHg (off antihypertensive medication).
Intervention:
The intervention was with dual- or triple-combination antihypertensive treatment: OM 40 mg/AML 10 mg/HCTZ 25 mg, OM 40 mg/AML 10 mg, OM 40 mg/HCTZ 25 mg, or AML 10 mg/HCTZ 25 mg.
Main Outcome Measure:
The primary efficacy variable was the change in least squares (LS) mean seated diastolic BP (SeDBP) from baseline to week 12. Secondary efficacy variables included the LS mean change in seated systolic BP (SeSBP), percentage of study participants reaching BP goal, and safety parameters.
Results:
In both Black and non-Black participants, triple-combination treatment resulted in significant and similar mean reductions in SeDBP and SeSBP (p ≤ 0.0001 vs each dual-combination treatment) with a greater proportion of participants reaching BP goal compared with dual-combination treatments, regardless of race. Most treatment-emergent adverse events were mild or moderate in severity and no new safety concerns were identified.
Conclusion:
Triple-combination treatment provided greater BP reductions than dual-combination treatments regardless of race.
Clinical Trial Registration:
Registered at ClinicalTrials.gov as NCT00649389.
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