24-month single-pill, triple antihypertensive therapy in rural Rwanda

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.

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.

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.

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.