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

Isabella Hunjan1,2, Clara Stroppa1,2, Alice Umulisa3

  • 1Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.

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|February 25, 2026
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Summary

Single-pill combination therapy for high blood pressure is feasible and effective long-term in rural Rwanda. This approach sustains blood pressure reduction for over 24 months in African populations.

Keywords:
Amlodipinearterial hypertensionhydrochlothiazideolmesartanpolypillsingle-pill combinationsub-Saharan Africa

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Area of Science:

  • Cardiology
  • Public Health
  • Pharmacology

Background:

  • Arterial hypertension is a major modifiable cardiovascular risk factor.
  • Recent guidelines advocate single-pill, low-dose combinations for initial hypertension management.
  • Feasibility in remote, rural sub-Saharan Africa remains under-investigated.

Purpose of the Study:

  • To assess the long-term feasibility and sustained effect of single-pill combination therapy for hypertension.
  • To evaluate this strategy in a remote rural area of Southern Rwanda.

Main Methods:

  • Hypertension diagnosed via validated oscillometric device (OMRON M7 IT-HEM-7322-E) using European Society of Hypertension criteria.
  • Participants initiated on a single-pill combination of amlodipine, hydrochlorothiazide, and olmesartan.
  • Treatment dosage adjusted at outpatient clinic visits; follow-up up to 24 months.

Main Results:

  • 57 participants with untreated hypertension (median age 65 years) were followed for up to 24 months.
  • Blood pressure <140/90 mmHg achieved in 65% at 1 month, 89% at 3 months, and 83% at 24 months.
  • Sustained blood pressure reduction observed throughout the 24-month follow-up period.

Conclusions:

  • Once-daily single-pill combination therapy is feasible for long-term hypertension management in rural sub-Saharan Africa.
  • The blood pressure-lowering effect is sustained for at least 24 months.
  • Single-pill combinations should be accessible in remote, low- and middle-income country settings.