Combination Blood Pressure Medications Prove Effective for South Asian Population

A new study conducted across India has found that different combinations of blood pressure medications are equally effective in treating hypertension among South Asian adults. The findings, presented at the American Heart Association's Scientific Sessions 2024 in Chicago, could have far-reaching implications for the treatment of high blood pressure in one of the world's largest populations.

The TOPSPIN trial, led by Dr. Dorairaj Prabhakaran of the Centre for Chronic Disease Control in New Delhi, involved nearly 2,000 adults aged 30 to 79. Participants were randomly assigned to one of three groups, each receiving a single pill combining two commonly prescribed blood pressure medications. The combinations tested were amlodipine and perindopril, perindopril and indapamide, or amlodipine and indapamide.

After six months of treatment, all three medication combinations proved equally effective in lowering blood pressure. Approximately 70% of participants achieved blood pressure readings below 140/90 mm Hg, with over 40% reaching the stricter target of less than 130/80 mm Hg. The absolute reduction in blood pressure was substantial, with office measurements showing a decrease of about 30/14 mm Hg and 24-hour ambulatory monitoring indicating a reduction of 14/8 mm Hg.

The study's findings are particularly significant given the prevalence of hypertension in South Asia. With 300 million people affected by high blood pressure in India alone, and South Asians comprising one-quarter of the global population, the results could inform treatment strategies for millions of individuals. The research also has relevance for the more than five million South Asians living in the United States.

Notably, the study found that all three medication combinations had excellent safety profiles, with less than 3% of participants discontinuing treatment due to adverse effects. This high level of tolerability is crucial for ensuring patient adherence to long-term hypertension management.

The TOPSPIN trial's results contrast with those of the CREOLE study, which examined similar medication combinations in Black adults with hypertension in Sub-Saharan Africa and found amlodipine-based combinations to be superior. This difference highlights the importance of conducting population-specific research to optimize treatment strategies.

Dr. Prabhakaran emphasized the study's strengths, including its diverse participant pool across India, encompassing a wide age range, both genders, and individuals with and without Type 2 diabetes. However, he noted that about 17% of participants did not complete the six-month study, which is a limitation to consider.

The findings align with recent recommendations from the American Heart Association, which encourage healthcare professionals to simplify medication regimens for people with hypertension, such as through the use of combination pills or fixed-dose combinations. This approach can potentially improve medication adherence and, consequently, blood pressure control.

As hypertension remains a significant global health burden, affecting nearly half of all U.S. adults, the TOPSPIN trial's results offer valuable insights into effective treatment options for a large and diverse population. The study underscores the importance of tailored approaches to hypertension management and may lead to more targeted and efficient treatment strategies for South Asian individuals worldwide.