Initiating triple therapy with bisoprolol, perindopril, and amlodipine achieved a greater reduction in systolic blood pressure at 8 weeks compared to continuing dual therapy (MD -7.3 mmHg; 95% CI -9.0 to -5.5).
Cohort (n=2,144)
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Does triple therapy (bisoprolol, perindopril, amlodipine) improve blood pressure reduction and control compared to continuing dual therapy in adults with uncontrolled hypertension?
In a real-world primary care setting, stepping up to triple therapy with bisoprolol, perindopril, and amlodipine significantly improved blood pressure reduction and doubled the likelihood of achieving BP control compared to remaining on dual therapy in patients with uncontrolled hypertension.
Mean Difference: -7.3 (95% CI -9–-5.5)
Objective: To compare systolic/diastolic blood pressure (SBP/DBP) change and BP control at 8 weeks between uncontrolled hypertensive adults in real-life setting in primary care in the UK on dual therapy initiating a third compound among bisoprolol/perindopril/amlodipine (triple therapy) and those staying on dual therapy (any two of the three). Design and method: A retrospective real-world observational cohort study (EUPAS1000000374) was conducted using the Clinical Research Datalink (CPRD). Eligible patients were adults with uncontrolled SBP (>=140 mmHg) who, after >=4 weeks on two drugs, either added a third drug (bisoprolol, perindopril, or amlodipine) or continued dual therapy. Patients were identified between Janv 2005 and Sept 2019. The primary endpoint was the change in SBP at 8 weeks. Secondary endpoints included DBP change and BP control rate (SBP60% male, ∼35% obese, 85% with >=1 comorbidity, mainly coronary artery disease, dyslipidaemia and diabetes. At 8 weeks, triple therapy perindopril+amlodipine+bisoprolol achieved greater BP reduction than dual therapy: mean SBP: –7.3 mmHg (95% CI: -9.0 to -5.5) and DBP: –3.9 mmHg (95% CI: –4.9 to –2.8). Results were consistent across all sensitivity analyses. BP control was reached in 29.5% of triple-therapy vs 13.2% of dual-therapy patients (risk ratio 2.2; 95% CI: 1.7-3.1). QBA showed no indication of residual confounding influencing the treatment effect.Conclusions: This study provides the first real-world evaluation of the effectiveness of a combination of bisoprolol+perindopril+amlodipine. Triple therapy demonstrated greater BP reductions and doubled the likelihood of achieving BP control than dual therapy.
Tsioufis et al. (Fri,) conducted a cohort in Uncontrolled hypertension (n=2,144). Triple therapy (bisoprolol, perindopril, amlodipine) vs. Dual therapy (any two of bisoprolol, perindopril, amlodipine) was evaluated on Change in SBP at 8 weeks (MD -7.3 mmHg, 95% CI -9.0 to -5.5). Initiating triple therapy with bisoprolol, perindopril, and amlodipine achieved a greater reduction in systolic blood pressure at 8 weeks compared to continuing dual therapy (MD -7.3 mmHg; 95% CI -9.0 to -5.5).